Healthcare Provider Details

I. General information

NPI: 1013019223
Provider Name (Legal Business Name): BERYL R FRUTH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510B W UNION ST
ATHENS OH
45701-2331
US

IV. Provider business mailing address

510B W UNION ST
ATHENS OH
45701-2331
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-7314
  • Fax:
Mailing address:
  • Phone: 740-593-7314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.042680
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: