Healthcare Provider Details

I. General information

NPI: 1821091414
Provider Name (Legal Business Name): DOUGLAS H MUSSER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 BOARDMAN CANFIELD RD
BOARDMAN OH
44512-4008
US

IV. Provider business mailing address

6470 TIPPECANOE RD
CANFIELD OH
44406-7036
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-0577
  • Fax: 330-533-4587
Mailing address:
  • Phone: 330-758-0577
  • Fax: 330-758-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34.007068
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number34.007068
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: