Jonathan Marion Detrick, M.D.

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

35043922 Issued in OH

Practice address

5757 Monclova Rd
Suite 14
Maumee, OH 43537-1863

Phone

(419) 893-3316

Fax

(419) 893-2320

NPI assigned

Oct 18, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213142400000",
    "number": "1861481202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5757 MONCLOVA RD",
            "address_2": "SUITE 14",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371863",
            "telephone_number": "419-893-3316",
            "fax_number": "419-893-2320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5757 MONCLOVA RD",
            "address_2": "SUITE 14",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371863",
            "telephone_number": "419-893-3316",
            "fax_number": "419-893-2320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETRICK",
        "first_name": "JONATHAN",
        "middle_name": "MARION",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2008-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "OH",
            "license": "35043922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB3101",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0513331",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dental Reflections Delbert a Davis DMD & William B Gardiner DDS Inc
• Barry P Deran, M.D.
• Kelly Desch, RN
• Heather Deselms, LPN
• Avinash S. Deshmukh, M.D.
• Michaela Dewese, LISW
• Laura Dick
• Yuriko Dickey
• Katherine Didion, PCC
• Lisa Anne Dille, LPCC

• Gynecology Physician in Maumee, OH
• Providers in Maumee, OH by specialty
• Gynecology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.