Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 35.092047 | OH |
NPI | 1003015066 |
---|---|
Provider Name | Dr. Jason Dean Eidahl |
First Address | Columbus, OH 43240-4006 |
Second Address | Akron, OH 44304-1619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 04/08/2008 |