Healthcare Provider Details

I. General information

NPI: 1891772216
Provider Name (Legal Business Name): BETH E DUVALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SUGAR CAMP CIR SUITE 140
OAKWOOD OH
45409-1962
US

IV. Provider business mailing address

105 SUGAR CAMP CIR SUITE 140
OAKWOOD OH
45409-1962
US

V. Phone/Fax

Practice location:
  • Phone: 937-395-3622
  • Fax: 937-395-3646
Mailing address:
  • Phone: 937-395-3622
  • Fax: 937-395-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.067958
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.067958
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: