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General NPI Number Information
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NPI Number | 1467621854
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Entity Type | Organization
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Legal Business Name | ERIC J PAUL
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 6693 N CHESTNUT ST STE 12B
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City | RAVENNA
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State | OH
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Zip | 44266-3900
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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 | 6693 N CHESTNUT ST STE 12B
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City | RAVENNA
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State | OH
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Zip | 44266-3900
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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 | OWNER
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Name | ERIC JAN PAUL
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Credential | DPM
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Telephone | 330-297-1211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 36002415
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License Number State | OH
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