Healthcare Provider Details

I. General information

NPI: 1912995812
Provider Name (Legal Business Name): GEORGE ELWOOD ESHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SCIOTO TRL
PORTSMOUTH OH
45662-2845
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 740-354-7769
  • Fax: 740-353-8978
Mailing address:
  • Phone: 606-408-4000
  • Fax: 606-408-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47366
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00007427
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: