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General NPI Number Information
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NPI Number | 1881886984
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Entity Type | Organization
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Legal Business Name | LEWISBURG FAMILY PRACTICE, INC
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 405 W GRAND AVE
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City | DAYTON
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State | OH
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Zip | 45405-7538
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Country | US
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Telephone | 937-395-6665
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Fax | 937-395-6668
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Provider Business Mailing Address
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Address Line | PO BOX 578
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City | LEWISBURG
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State | OH
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Zip | 45338-0578
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Country | US
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Telephone | 937-962-2618
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Fax | 937-962-4971
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL TODD BOGGS
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Credential | MD
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Telephone | 937-962-2618
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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 | 35067136
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License Number State | OH
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