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General NPI Number Information
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NPI Number | 1336264209
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Entity Type | Organization
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Legal Business Name | SOUTHMOOR MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 38 SOUTHMOOR CIR NE
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City | KETTERING
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State | OH
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Zip | 45429-2443
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Country | US
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Telephone | 937-294-4487
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Fax | 937-294-2255
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Provider Business Mailing Address
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Address Line | 38 SOUTHMOOR CIR NE
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City | KETTERING
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State | OH
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Zip | 45429-2443
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Country | US
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Telephone | 937-294-4487
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Fax | 937-294-2255
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN JEROME HOCHWALT
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Credential |
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Telephone | 937-294-4487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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