Healthcare Provider Details

I. General information

NPI: 1811946536
Provider Name (Legal Business Name): JAMES JOSEPH ENYEART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E LIBERTY ST
GIRARD OH
44420-2649
US

IV. Provider business mailing address

121 E LIBERTY ST
GIRARD OH
44420
US

V. Phone/Fax

Practice location:
  • Phone: 330-545-8814
  • Fax: 330-545-5008
Mailing address:
  • Phone: 330-545-8814
  • Fax: 330-545-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number35042993
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: