Healthcare Provider Details

I. General information

NPI: 1285647214
Provider Name (Legal Business Name): PAUL C HESSLER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 MAPLE AVE
GORDON NE
69343-0174
US

IV. Provider business mailing address

PO BOX 174
GORDON NE
69343-0174
US

V. Phone/Fax

Practice location:
  • Phone: 401-578-6687
  • Fax:
Mailing address:
  • Phone: 401-578-6687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD5355
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5355
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: