Healthcare Provider Details

I. General information

NPI: 1013023035
Provider Name (Legal Business Name): EMMETT H BROXSON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1898
US

IV. Provider business mailing address

7570 DEEP WOODS CT
SPRINGBORO OH
45066-8570
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3111
  • Fax: 937-641-5885
Mailing address:
  • Phone: 937-748-4534
  • Fax: 937-641-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number35056878
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: