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General NPI Number Information
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NPI Number | 1780900654
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Entity Type | Organization
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Legal Business Name | JAMES J ENYEART MD INC
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Dates
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Enumeration Date | 04/16/2010
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 121 E LIBERTY ST
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City | GIRARD
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State | OH
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Zip | 44420-2649
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Country | US
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Telephone | 330-545-8814
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Fax | 330-545-5008
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Provider Business Mailing Address
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Address Line | 121 E LIBERTY ST
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City | GIRARD
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State | OH
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Zip | 44420-2649
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Country | US
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Telephone | 330-545-8814
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Fax | 330-545-5008
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES JOSEPH ENYEART
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Credential | M.D.
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Telephone | 330-545-8814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 35042993
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License Number State | OH
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