Healthcare Provider Details

I. General information

NPI: 1023135340
Provider Name (Legal Business Name): EDWARD L. ERB, D.O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 FAR HILLS AVE SUITE201
DAYTON OH
45429-2386
US

IV. Provider business mailing address

4345 DELCO DELL RD
DAYTON OH
45429-1210
US

V. Phone/Fax

Practice location:
  • Phone: 937-291-0657
  • Fax: 937-291-0775
Mailing address:
  • Phone: 937-298-5333
  • Fax: 937-298-5923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number34006491
License Number StateOH

VIII. Authorized Official

Name: DR. EDWARD L ERB
Title or Position: OWNER
Credential: D.O.
Phone: 937-223-7106