=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881094142
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID FRANCOIS-XAVIER DUFRESNE M.D., FRCPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2014
-----------------------------------------------------
Last Update Date | 08/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9500 EUCLID AVE EPILEPSY CENTER
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44195-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-445-9818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3337 E SCARBOROUGH RD
-----------------------------------------------------
City | CLEVELAND HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44118-3410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-333-6646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0600X
-----------------------------------------------------
Taxonomy Name | Clinical Neurophysiology Physician
-----------------------------------------------------
License Number | 57.024022
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0402X
-----------------------------------------------------
Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
-----------------------------------------------------
License Number | 2028712
-----------------------------------------------------
License Number State | ZZ
-----------------------------------------------------