Healthcare Provider Details

I. General information

NPI: 1033744909
Provider Name (Legal Business Name): JOSHUA GRAY COMPSTON IDMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4884 SUGAR MAPLE DR
DAYTON OH
45433-5533
US

IV. Provider business mailing address

4884 SUGAR MAPLE DR
DAYTON OH
45433-5533
US

V. Phone/Fax

Practice location:
  • Phone: 937-904-8498
  • Fax:
Mailing address:
  • Phone: 937-904-8498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: