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General NPI Number Information
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NPI Number | 1063402287
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Entity Type | Individual
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Provider Name | EDWIN THOMAS BROTT MD
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 2204 LEXINGTON AVENUE
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City | ASHLAND
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State | KY
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Zip | 41101
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Country | US
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Telephone | 513-300-0149
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Fax |
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Provider Business Mailing Address
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Address Line | 2208 SOUTH RD
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City | CINCINNATI
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State | OH
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Zip | 45233-4267
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Country | US
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Telephone | 513-300-0149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 31144
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 62695
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License Number State | OH
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