Healthcare Provider Details

I. General information

NPI: 1689688871
Provider Name (Legal Business Name): DONALD EDWARD FUERST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4439 STATE ROUTE 159 SUITE 280
CHILLICOTHEE OH
45601-8207
US

IV. Provider business mailing address

4439 STATE ROUTE 159 SUITE 280
CHILLICOTHEE OH
45601-8207
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4370
  • Fax: 740-779-4379
Mailing address:
  • Phone: 740-779-4370
  • Fax: 740-779-4379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35.046103
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: