MEDICARE: ERIC J PAUL DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	36002415P	OH

General Provider Information

NPI Number	:	1013979970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC J PAUL DPM

Provider Business Mailing Address
First Line	:	PO BOX 228
Second Line	:	6693 NORTH CHESTNUT ST STE 12-B
City	:	RAVENNA
State	:	OH
Zip	:	44266-0228
Country	:	US
Telephone Number	:	330-297-1211
Fax Number	:	330-297-6550

Provider Business Practice Location Address
First Line	:	6693 NORTH CHESTNUT ST
Second Line	:	STE 12-B
City	:	RAVENNA
State	:	OH
Zip	:	44266
Country	:	US
Telephone Number	:	330-297-1211
Fax Number	:	330-297-6550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	05/13/2011

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