Healthcare Provider Details

I. General information

NPI: 1275582033
Provider Name (Legal Business Name): PAUL S. JEPPSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS 600 HIGHLAND AVE. ROOM H4/831-8320
MADISON WI
53792-0001
US

IV. Provider business mailing address

UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS 600 HIGHLAND AVE. ROOM H4/831-8320
MADISON WI
53792-0001
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-0572
  • Fax:
Mailing address:
  • Phone: 608-263-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number48353
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: