Provider Demographics
NPI:1467686071
Name:BROXTERMAN, LAURA THOMAN (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:THOMAN
Last Name:BROXTERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 HARRISON AVE
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-1691
Mailing Address - Country:US
Mailing Address - Phone:513-922-6666
Mailing Address - Fax:513-922-1812
Practice Address - Street 1:5885 HARRISON AVE
Practice Address - Street 2:SUITE 3100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-1691
Practice Address - Country:US
Practice Address - Phone:513-922-6666
Practice Address - Fax:513-922-1812
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.121313207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0086721Medicaid
KY7100247720Medicaid
000000825937OtherANTHEM PROVIDER ID
OHH247400Medicare PIN