Provider Demographics
NPI:1710936505
Name:ERVINE, WILLIAM E JR (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:ERVINE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-632-0408
Mailing Address - Fax:440-632-0601
Practice Address - Street 1:15976 E HIGH ST
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9474
Practice Address - Country:US
Practice Address - Phone:440-632-0408
Practice Address - Fax:440-632-0601
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2020-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01202202039207Q00000X
OH34-008594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710936505Medicaid
OH2648586Medicaid
P00444859OtherRAILROAD MEDICARE
P00444859OtherRAILROAD MEDICARE