Healthcare Provider Details

I. General information

NPI: 1356427140
Provider Name (Legal Business Name): JEFFREY BRUCE STUDEBAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 MOSIER PKWY
BROOKVILLE OH
45309-1750
US

IV. Provider business mailing address

98 MOSIER PKWY
BROOKVILLE OH
45309-1750
US

V. Phone/Fax

Practice location:
  • Phone: 937-833-4103
  • Fax: 937-833-3147
Mailing address:
  • Phone: 937-833-4103
  • Fax: 937-833-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35 044532
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: