Individual
JON G DIVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
222 PIEDMONT AVE, ML 0212, CINCINNATI, OH 45219-4231
(513) 475-8690
(513) 475-7593
Mailing address
222 PIEDMONT AVE, ML 0212, CINCINNATI, OH 45219-4231
(513) 475-8690
(513) 475-7593
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
35-070497
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2475503
—
OH
05
—
64077175
—
KY
Enumeration date
07/20/2006
Last updated
10/17/2013
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