=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396927109
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | F.E.YUZON, M.D. INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2007
-----------------------------------------------------
Last Update Date | 11/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3600 KOLBE RD SUITE 205
-----------------------------------------------------
City | LORAIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44053-1654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-960-6430
-----------------------------------------------------
Fax | 440-960-6434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3600 KOLBE RD SUITE 205
-----------------------------------------------------
City | LORAIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44053-1654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-960-6430
-----------------------------------------------------
Fax | 440-960-6434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLER
-----------------------------------------------------
Name | DIANA SOOY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 440-960-6430
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 35035173
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------