Healthcare Provider Details

I. General information

NPI: 1851316798
Provider Name (Legal Business Name): BETSY A BROGAN D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 VERNON PL SUITE 302
CINCINNATI OH
45219-2425
US

IV. Provider business mailing address

6200 PLEASANT AVE SUITE 3
FAIRFIELD OH
45014-4670
US

V. Phone/Fax

Practice location:
  • Phone: 513-381-4042
  • Fax: 513-345-6632
Mailing address:
  • Phone: 513-829-9333
  • Fax: 513-858-7827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36-00-3262B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: