Healthcare Provider Details

I. General information

NPI: 1952708786
Provider Name (Legal Business Name): DR. PAUL WILSON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 S REYNOLDS RD STE B
TOLEDO OH
43615-5900
US

IV. Provider business mailing address

PO BOX 8440
TOLEDO OH
43623-0440
US

V. Phone/Fax

Practice location:
  • Phone: 419-386-9555
  • Fax:
Mailing address:
  • Phone: 419-885-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number34002939W
License Number StateOH

VIII. Authorized Official

Name: DR. PAUL W WILSON
Title or Position: OWNER
Credential: MD
Phone: 419-386-9555