Provider Demographics
NPI:1326046798
Name:YOON, ERIC JAMES (DNP)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JAMES
Last Name:YOON
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162-1205
Mailing Address - Country:US
Mailing Address - Phone:614-879-7100
Mailing Address - Fax:614-879-7151
Practice Address - Street 1:95 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162
Practice Address - Country:US
Practice Address - Phone:614-879-7100
Practice Address - Fax:614-879-7151
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2019-05-03
Deactivation Date:2005-09-21
Deactivation Code:
Reactivation Date:2006-10-27
Provider Licenses
StateLicense IDTaxonomies
OHNP05791363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
11472240OtherCAQH
OH000000231451OtherANTHEM
OH500029439OtherRR MEDICARE
OH2267943Medicaid
OH2267943Medicaid
OH$$$$$$$$$00OtherBWC
OH500029439OtherRR MEDICARE
OH$$$$$$$$$00OtherBWC
OH500029439OtherRR MEDICARE