MEDICARE: DR. JEFFERY WAYNE PAULSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0000X	Adolescent Medicine (Family Medicine) Physician	G63842	CA

General Provider Information

NPI Number	:	1407820426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY WAYNE PAULSON MD

Provider Business Mailing Address
First Line	:	618 SHADOW TREE DR
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-7419
Country	:	US
Telephone Number	:	760-443-5621
Fax Number	:

Provider Business Practice Location Address
First Line	:	FLEET FORCES COMMAND
Second Line	:	1562 MITSCHER AVE, STE 250
City	:	NORFOLK
State	:	VA
Zip	:	23551-0001
Country	:	US
Telephone Number	:	757-836-0106
Fax Number	:	757-836-5499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/08/2007

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