Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 7564 | OH |
NPI | 1013054980 |
---|---|
Provider Name | Eric Fete |
First Address | Canton, OH 44718-2545 |
Second Address | Cambridge, OH 43725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 05/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2258542 | (05) | OH |
3810008966 | (05) | WV |