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General NPI Number Information
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NPI Number | 1033156104
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Entity Type | Individual
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Provider Name | DAVID R DIDUR DO
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Gender | Male
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 400 AUSTIN AVE NW
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City | MASSILLON
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State | OH
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Zip | 44646-3598
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Country | US
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Telephone | 216-837-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 12521 ELLSWORTH RD
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City | NORTH JACKSON
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State | OH
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Zip | 44451
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Country | US
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Telephone |
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 34005849
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License Number State | OH
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