MEDICARE: PAUL DAVID WESSON II DO

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	34006208	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659362176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL DAVID WESSON II DO

Provider Business Mailing Address
First Line	:	PO BOX 418
Second Line	:
City	:	KENTON
State	:	OH
Zip	:	43326-0418
Country	:	US
Telephone Number	:	419-675-1962
Fax Number	:	419-673-8058

Provider Business Practice Location Address
First Line	:	75 WASHINGTON BLVD
Second Line	:	#101
City	:	KENTON
State	:	OH
Zip	:	43326-4001
Country	:	US
Telephone Number	:	419-675-1962
Fax Number	:	419-673-8058

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	01/25/2022

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