Healthcare Provider Details

I. General information

NPI: 1154383875
Provider Name (Legal Business Name): PAUL WINDHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 HARRISON AVE STE A
EUREKA CA
95501-3230
US

IV. Provider business mailing address

3144 BROADWAY STE 4-314
EUREKA CA
95501-3838
US

V. Phone/Fax

Practice location:
  • Phone: 707-497-6342
  • Fax: 707-497-6234
Mailing address:
  • Phone: 707-497-6342
  • Fax: 707-497-6234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG57950
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG057950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: