Healthcare Provider Details

I. General information

NPI: 1508811951
Provider Name (Legal Business Name): STEPHANIE BROUGHTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 NEW HAVEN RD
HARRISON OH
45030-2780
US

IV. Provider business mailing address

10450 NEW HAVEN RD
HARRISON OH
45030-2780
US

V. Phone/Fax

Practice location:
  • Phone: 513-981-5852
  • Fax: 513-367-8031
Mailing address:
  • Phone: 513-981-5852
  • Fax: 513-367-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34006667
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: