Provider Demographics
NPI:1144288259
Name:SIZEMORE, JEFFREY EUGENE III (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EUGENE
Last Name:SIZEMORE
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:740 WOODBINE ST
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-1635
Mailing Address - Country:US
Mailing Address - Phone:419-935-6761
Mailing Address - Fax:419-933-1676
Practice Address - Street 1:740 WOODBINE ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-1635
Practice Address - Country:US
Practice Address - Phone:419-935-6761
Practice Address - Fax:419-933-1676
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0587695Medicare PIN