Healthcare Provider Details

I. General information

NPI: 1477552339
Provider Name (Legal Business Name): JAMES A EWRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 BEAVER CREEK CIR SUITE 110
MAUMEE OH
43537-1745
US

IV. Provider business mailing address

660 BEAVER CREEK CIR SUITE 110
MAUMEE OH
43537-1745
US

V. Phone/Fax

Practice location:
  • Phone: 419-891-6210
  • Fax: 419-893-3232
Mailing address:
  • Phone: 419-891-6210
  • Fax: 419-893-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35054027
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: