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General NPI Number Information
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NPI Number | 1366791410
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Entity Type | Organization
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Legal Business Name | JONATHAN T EUCKER MD LLC
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 2652 ELM RD NE
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City | CORTLAND
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State | OH
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Zip | 44410-9393
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Country | US
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Telephone | 330-841-1090
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Fax | 330-841-1091
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Provider Business Mailing Address
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Address Line | 2652 ELM RD NE
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City | CORTLAND
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State | OH
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Zip | 44410-9393
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Country | US
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Telephone | 330-841-1090
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Fax | 330-841-1091
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN TRENT EUCKER
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Credential | MD
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Telephone | 330-841-1090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 35073212
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License Number State | OH
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