Healthcare Provider Details

I. General information

NPI: 1295728459
Provider Name (Legal Business Name): EDWARD R BROUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4777 E GALBRAITH RD STE 320
CINCINNATI OH
45236-2725
US

IV. Provider business mailing address

5053 WOOSTER RD
CINCINNATI OH
45226-2326
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-2273
  • Fax: 513-751-1840
Mailing address:
  • Phone: 513-751-2145
  • Fax: 513-751-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number31986
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01033350A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35070569
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: