Healthcare Provider Details

I. General information

NPI: 1285332684
Provider Name (Legal Business Name): ANDREW W WAYMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 BELLEFONTAINE AVE STE 125
LIMA OH
45804-1867
US

IV. Provider business mailing address

1003 BELLEFONTAINE AVE STE 125
LIMA OH
45804-1867
US

V. Phone/Fax

Practice location:
  • Phone: 419-998-8207
  • Fax: 419-998-8216
Mailing address:
  • Phone: 419-998-8207
  • Fax: 419-998-8216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008036RX
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: