Healthcare Provider Details

I. General information

NPI: 1265433643
Provider Name (Legal Business Name): PAUL RICHARD HEDGES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342B TABLE ROCK LANE
WHEELING WV
26003
US

IV. Provider business mailing address

342B TABLE ROCK LANE
WHEELING WV
26003
US

V. Phone/Fax

Practice location:
  • Phone: 304-277-5261
  • Fax: 304-232-7033
Mailing address:
  • Phone: 304-277-5261
  • Fax: 304-232-7033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number09808
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: