Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 35056878 | OH |
NPI | 1013023035 |
---|---|
Provider Name | Dr. Emmett H Broxson JR. |
First Address | Springboro, OH 45066-8570 |
Second Address | Dayton, OH 45404-1898 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 21/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0828715 | (05) | OH |
0828715 | BCMH (01) | OH |
35056878 | LICENSE (01) | ND |
BB2250544 | DEA NUMBER (01) | OH |
F55924 | (02) | OH |