MEDICARE: ARCHIE D ENOCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35065803	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780683755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARCHIE D ENOCH MD

Provider Business Mailing Address
First Line	:	4172 INDIAN RIPPLE RD A
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45440-3286
Country	:	US
Telephone Number	:	937-431-3779
Fax Number	:	937-431-3776

Provider Business Practice Location Address
First Line	:	4172 INDIAN RIPPLE RD STE A
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45440-3286
Country	:	US
Telephone Number	:	937-431-3779
Fax Number	:	937-431-3776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	01/12/2021

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