Healthcare Provider Details

I. General information

NPI: 1538330360
Provider Name (Legal Business Name): STEPHEN GREGORY ESCUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 GLESSNER AVE
MANSFIELD OH
44903-2269
US

IV. Provider business mailing address

335 GLESSNER AVE
MANSFIELD OH
44903-2269
US

V. Phone/Fax

Practice location:
  • Phone: 419-526-8000
  • Fax:
Mailing address:
  • Phone: 419-526-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.092848
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301087597
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: