Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36002415P | OH |
Y | 222Z00000X | Podiatrist | 36002415P | OH |
NPI | 1013979970 |
---|---|
Provider Name | Eric J Paul |
First Address | Ravenna, OH 44266-0228 |
Second Address | Ravenna, OH 44266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 13/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T80646 | (02) |