Healthcare Provider Details

I. General information

NPI: 1073707378
Provider Name (Legal Business Name): EMILY JEAN MAUPIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY JEAN GEIER DO

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

6039 LANCASHIRE TRL
LIBERTY TOWNSHIP OH
45044-5782
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-3356
  • Fax:
Mailing address:
  • Phone: 513-505-4530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.009697
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: