Basic Information
Provider Information
NPI: 1285733964
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EYRE
FirstName: JOHN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 901543
Address2:  
City: CLEVELAND
State: OH
PostalCode: 441901543
CountryCode: US
TelephoneNumber: 4402502070
FaxNumber: 4402502071
Practice Location
Address1: 960 CLAGUE RD STE 3201
Address2:  
City: WESTLAKE
State: OH
PostalCode: 441451588
CountryCode: US
TelephoneNumber: 2163830100
FaxNumber: 2163836481
Other Information
ProviderEnumerationDate: 09/21/2006
LastUpdateDate: 11/18/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/18/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X35069582EOHY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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