Provider Demographics
NPI:1871596668
Name:KUNZ, JERRY M JR (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:M
Last Name:KUNZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1761
Mailing Address - Country:US
Mailing Address - Phone:740-779-6801
Mailing Address - Fax:740-779-6804
Practice Address - Street 1:201 N PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1761
Practice Address - Country:US
Practice Address - Phone:740-779-6801
Practice Address - Fax:740-779-6804
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2048466Medicaid
OH000000537026OtherANTHEM
OH0104896OtherUNITED HEALTHCARE
OHP00434243OtherRAILROAD MEDICARE
OH0891975Medicare PIN
OH000000537026OtherANTHEM