Provider Demographics
NPI:1083148944
Name:GUY B DEL PRINCE DPM INC
Entity Type:Organization
Organization Name:GUY B DEL PRINCE DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEL PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-998-7505
Mailing Address - Street 1:2139 W PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6439
Mailing Address - Country:US
Mailing Address - Phone:440-998-7505
Mailing Address - Fax:
Practice Address - Street 1:2139 W PROSPECT RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6439
Practice Address - Country:US
Practice Address - Phone:440-998-7505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.002972213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty