Healthcare Provider Details

I. General information

NPI: 1134103898
Provider Name (Legal Business Name): PAUL JEPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 HOSPITAL DR SUITE 201
UKIAH CA
95482-4533
US

IV. Provider business mailing address

PO BOX 2739
UKIAH CA
95482-2739
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-8000
  • Fax: 707-462-1111
Mailing address:
  • Phone: 707-463-8000
  • Fax: 707-462-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA23352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: