Provider Demographics
NPI:1659336279
Name:EPPES, ROBERT BENNETT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BENNETT
Last Name:EPPES
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 1:1611 S GREEN RD
Mailing Address - Street 2:SUITE 158
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4128
Mailing Address - Country:US
Mailing Address - Phone:216-382-9303
Mailing Address - Fax:216-382-8380
Practice Address - Street 1:1611 S GREEN RD
Practice Address - Street 2:SUITE 158
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4128
Practice Address - Country:US
Practice Address - Phone:216-382-9303
Practice Address - Fax:216-382-8380
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.028846207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000130375OtherANTHEM BLUE CROSS BLUE SH
OH0115422Medicaid
OHC00849Medicare UPIN
OH0115422Medicaid