Healthcare Provider Details

I. General information

NPI: 1407820426
Provider Name (Legal Business Name): JEFFERY WAYNE PAULSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FLEET FORCES COMMAND 1562 MITSCHER AVE, STE 250
NORFOLK VA
23551-0001
US

IV. Provider business mailing address

618 SHADOW TREE DR
OCEANSIDE CA
92054-7419
US

V. Phone/Fax

Practice location:
  • Phone: 757-836-0106
  • Fax: 757-836-5499
Mailing address:
  • Phone: 760-443-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberG63842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: