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General NPI Number Information
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NPI Number | 1740453984
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Entity Type | Organization
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Legal Business Name | SPRINGBORO FAMILY MEDICINE INC
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 5 SYCAMORE CREEK DRIVE
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City | SPRINGBORO
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State | OH
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Zip | 45066
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Country | US
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Telephone | 937-748-4211
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Fax | 937-748-3566
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Provider Business Mailing Address
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Address Line | 5 SYCAMORE CREEK DRIVE
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City | SPRINGBORO
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State | OH
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Zip | 45066
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Country | US
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Telephone | 937-748-4211
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Fax | 937-748-3566
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MRS. SUSAN BETH GRAU
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Credential | MD
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Telephone | 937-748-4211
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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 | 34008059M
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License Number State | OH
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Taxonomy #2
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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 | OH
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