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General NPI Number Information
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NPI Number | 1013979970
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Entity Type | Individual
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Provider Name | ERIC J PAUL DPM
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Gender | Male
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | 6693 NORTH CHESTNUT ST STE 12-B
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City | RAVENNA
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State | OH
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Zip | 44266
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Country | US
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Telephone | 330-297-1211
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Fax | 330-297-6550
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Provider Business Mailing Address
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Address Line | PO BOX 228 6693 NORTH CHESTNUT ST STE 12-B
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City | RAVENNA
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State | OH
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Zip | 44266-0228
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Country | US
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Telephone | 330-297-1211
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Fax | 330-297-6550
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36002415P
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License Number State | OH
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