Provider Demographics
NPI:1013979970
Name:PAUL, ERIC J (DPM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:PAUL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:6693 NORTH CHESTNUT ST STE 12-B
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-0228
Mailing Address - Country:US
Mailing Address - Phone:330-297-1211
Mailing Address - Fax:330-297-6550
Practice Address - Street 1:6693 NORTH CHESTNUT ST
Practice Address - Street 2:STE 12-B
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266
Practice Address - Country:US
Practice Address - Phone:330-297-1211
Practice Address - Fax:330-297-6550
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002415P213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T80646Medicare UPIN
0614232Medicare ID - Type Unspecified