Provider Demographics
NPI:1891772216
Name:DUVALL, BETH E (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:E
Last Name:DUVALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 SUGAR CAMP CIR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1962
Mailing Address - Country:US
Mailing Address - Phone:937-395-3622
Mailing Address - Fax:937-395-3646
Practice Address - Street 1:105 SUGAR CAMP CIR
Practice Address - Street 2:SUITE 140
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45409-1962
Practice Address - Country:US
Practice Address - Phone:937-395-3622
Practice Address - Fax:937-395-3646
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.067958207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0227025Medicaid
OHH09968Medicare UPIN
OH0838894Medicare PIN