Healthcare Provider Details

I. General information

NPI: 1043428816
Provider Name (Legal Business Name): DANIEL JOSIAH FAX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8054 DARROW RD STE 3
TWINSBURG OH
44087-2381
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-425-3344
  • Fax: 330-425-8847
Mailing address:
  • Phone: 330-543-3733
  • Fax: 330-543-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.010706
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.091227
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: