Healthcare Provider Details

I. General information

NPI: 1366632960
Provider Name (Legal Business Name): JAMES B. NAGLE, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E STROOP RD
KETTERING OH
45429-2825
US

IV. Provider business mailing address

PO BOX 292558
KETTERING OH
45429-0558
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-5352
  • Fax: 937-293-5566
Mailing address:
  • Phone: 937-293-5352
  • Fax: 937-293-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number35039117
License Number StateOH

VIII. Authorized Official

Name: MRS. AMY N DAHM
Title or Position: BILLING
Credential:
Phone: 937-293-5352