MEDICARE: BOBBY W PAUL M.D.

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	207R00000X	Internal Medicine Physician	35-063082	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000665745	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P63082	OTHER	OH	SUMMACARE
4	4411484	OTHER	OH	AETNA

General Provider Information

NPI Number	:	1902852148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBY W PAUL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6230
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-0722
Country	:	US
Telephone Number	:	304-242-7106
Fax Number	:	304-242-7108

Provider Business Practice Location Address
First Line	:	1440 ROCKSIDE RD STE 101
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-2749
Country	:	US
Telephone Number	:	216-749-8277
Fax Number	:	216-749-8273

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	09/04/2024

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Directions to “ BOBBY W PAUL M.D.” Practice Location

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