=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912960329
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES BOYD NAGLE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2006
-----------------------------------------------------
Last Update Date | 11/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 TAIT RD
-----------------------------------------------------
City | KETTERING
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45429-1125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-293-5352
-----------------------------------------------------
Fax | 937-885-1024
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 292558
-----------------------------------------------------
City | KETTERING
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45429-0558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-293-5352
-----------------------------------------------------
Fax | 937-293-5566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 35039117
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------