Healthcare Provider Details

I. General information

NPI: 1194777292
Provider Name (Legal Business Name): RUBEN SALES ESCURO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RUBEN S ESCURO M.D.

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41201 SCHADDEN ROAD SUITE 2
ELYRIA OH
44035-2220
US

IV. Provider business mailing address

41201 SCHADDEN ROAD SUITE 2
ELYRIA OH
44035-2220
US

V. Phone/Fax

Practice location:
  • Phone: 440-324-0401
  • Fax: 440-324-0405
Mailing address:
  • Phone: 440-324-0401
  • Fax: 440-324-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number53202
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: