Healthcare Provider Details

I. General information

NPI: 1659362176
Provider Name (Legal Business Name): PAUL DAVID WESSON II DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 01/25/2022
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WASHINGTON BLVD #101
KENTON OH
43326-4001
US

IV. Provider business mailing address

PO BOX 418
KENTON OH
43326-0418
US

V. Phone/Fax

Practice location:
  • Phone: 419-675-1962
  • Fax: 419-673-8058
Mailing address:
  • Phone: 419-675-1962
  • Fax: 419-673-8058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34006208
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: