Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 34.013314 | OH |
Y | 208600000X | Surgeon | 34.013314 | OH |
NPI | 1003275801 |
---|---|
Provider Name | Elsworth Charles Beach |
First Address | Cuyahoga Falls, OH 44223-1404 |
Second Address | Canton, OH 44708-4676 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2016 |
Last Update Date | 02/08/2021 |