Healthcare Provider Details

I. General information

NPI: 1285030577
Provider Name (Legal Business Name): OHIO PODIATRIC PHYSICIAN AND SURGEONS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3553 DARROW RD
STOW OH
44224-4008
US

IV. Provider business mailing address

335 E WATERLOO RD
AKRON OH
44319-1218
US

V. Phone/Fax

Practice location:
  • Phone: 330-688-7764
  • Fax: 330-688-7876
Mailing address:
  • Phone: 330-724-8689
  • Fax: 330-724-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36-00-3300D
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36-00-3300D
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number36-00-3300D
License Number StateOH

VIII. Authorized Official

Name: DR. JEREMY FRANKLIN DAVIS
Title or Position: PHYSICIAN
Credential: DPM
Phone: 330-688-7764