Healthcare Provider Details

I. General information

NPI: 1881192367
Provider Name (Legal Business Name): ROBERT MILTON PHELPS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2252 ENCORE DR
DAYTON OH
45424-5112
US

IV. Provider business mailing address

2252 ENCORE DR
DAYTON OH
45424-5112
US

V. Phone/Fax

Practice location:
  • Phone: 937-725-2682
  • Fax:
Mailing address:
  • Phone: 937-725-2682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: