Healthcare Provider Details

I. General information

NPI: 1306003769
Provider Name (Legal Business Name): EMILY CLAIRE SPEELMON M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S MAIN ST STE 2
DAYTON OH
45409-2643
US

IV. Provider business mailing address

1520 S MAIN ST STE 2
DAYTON OH
45409-2643
US

V. Phone/Fax

Practice location:
  • Phone: 937-461-5815
  • Fax: 937-461-2896
Mailing address:
  • Phone: 937-461-5815
  • Fax: 937-461-2896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD166946
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD166946
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35-128718
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: