Healthcare Provider Details

I. General information

NPI: 1083683148
Provider Name (Legal Business Name): PAUL W WEHBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RANDALL SQ SUITE 404-406
PROVIDENCE RI
02904-2709
US

IV. Provider business mailing address

1 RANDALL SQ SUITE 404-406
PROVIDENCE RI
02904-2709
US

V. Phone/Fax

Practice location:
  • Phone: 401-861-5183
  • Fax: 401-861-5276
Mailing address:
  • Phone: 401-861-5183
  • Fax: 401-861-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD09832
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: