Healthcare Provider Details

I. General information

NPI: 1538101431
Provider Name (Legal Business Name): FRANK E WASHBURN III DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 N BOONE RD
COLUMBIA STATION OH
44028-9649
US

IV. Provider business mailing address

PO BOX 1966
ELYRIA OH
44036-1966
US

V. Phone/Fax

Practice location:
  • Phone: 440-366-5600
  • Fax: 440-366-6766
Mailing address:
  • Phone: 440-366-5600
  • Fax: 440-366-6766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003016W
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: