Basic Information
| Provider Information | |||||||||
| NPI: | 1073740353 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SQUIBB | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | MURLEY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2145 N FAIRFIELD RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454312783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375583900 | ||||||||
| FaxNumber: | 9375583999 | ||||||||
| Practice Location | |||||||||
| Address1: | 6438 WILMINGTON PIKE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454597021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145660950 | ||||||||
| FaxNumber: | 6145660766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2009 | ||||||||
| LastUpdateDate: | 11/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.098163 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0065002 | 05 | OH | MEDICAID |