Healthcare Provider Details

I. General information

NPI: 1629048079
Provider Name (Legal Business Name): DARRELL LEROY WIDMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S MAIN ST SUITE B
RITTMAN OH
44270-1914
US

IV. Provider business mailing address

525 E MARKET ST PO BOX 2090
AKRON OH
44304-1619
US

V. Phone/Fax

Practice location:
  • Phone: 330-925-3857
  • Fax: 330-925-4016
Mailing address:
  • Phone: 330-996-0347
  • Fax: 330-996-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-07-1171-W
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: