Provider Demographics
NPI:1093771172
Name:SPEAKMAN, ERIC DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DOUGLAS
Last Name:SPEAKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PELRET PKWY #200
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-3200
Mailing Address - Country:US
Mailing Address - Phone:440-274-5000
Mailing Address - Fax:440-260-6153
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2433
Practice Address - Country:US
Practice Address - Phone:330-344-2025
Practice Address - Fax:330-344-6418
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072252207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000028654OtherANTHEM BLUE CROSS BLUE SHIELD
OH2012539Medicaid
OH$$$$$$$$$00OtherBUREAU OF WORKERS COMPENSATION
G53608Medicare UPIN
OH0826511Medicare ID - Type Unspecified
OH$$$$$$$$$00OtherBUREAU OF WORKERS COMPENSATION