MEDICARE: PAUL WESOLOW 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	207Q00000X	Family Medicine Physician	J1812	TX

General Provider Information

NPI Number	:	1407977960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL WESOLOW MD

Provider Business Mailing Address
First Line	:	PO BOX 949
Second Line	:
City	:	SOUR LAKE
State	:	TX
Zip	:	77659
Country	:	US
Telephone Number	:	409-287-2762
Fax Number	:

Provider Business Practice Location Address
First Line	:	517 S HWY 326
Second Line	:
City	:	SOUR LAKE
State	:	TX
Zip	:	77659
Country	:	US
Telephone Number	:	409-287-2762
Fax Number	:

Authorized Official
Title or Position	:	PAUL WESOLOW MD
Name	:	PAUL WESOLOW
Credential	:	MD
Telephone Number	:	409-287-2762

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	03/06/2008

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