Healthcare Provider Details

I. General information

NPI: 1174878482
Provider Name (Legal Business Name): RYAN LEE ESCHBAUGH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7442 FRANK AVE NW
NORTH CANTON OH
44720-7022
US

IV. Provider business mailing address

7442 FRANK AVE NW
NORTH CANTON OH
44720-7022
US

V. Phone/Fax

Practice location:
  • Phone: 330-305-0838
  • Fax: 330-491-2051
Mailing address:
  • Phone: 330-305-0838
  • Fax: 330-491-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34.012824
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: