Healthcare Provider Details

I. General information

NPI: 1194977793
Provider Name (Legal Business Name): MYRON G. ZUDER PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 N MAIN ST
AKRON OH
44310-3017
US

IV. Provider business mailing address

640 N MAIN ST
AKRON OH
44310-3017
US

V. Phone/Fax

Practice location:
  • Phone: 330-762-7481
  • Fax: 330-762-7484
Mailing address:
  • Phone: 330-762-7481
  • Fax: 330-762-7484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberE.0001405
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: