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NPI Code Detail

MEDICARE: DR. JEFFREY W WAHL M.D.

MEDICARE: DR. JEFFREY W WAHL 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
12084P0800XPsychiatry Physician35054045OH
22084P0804XChild & Adolescent Psychiatry Physician35054045OH

Other Identifiers

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

General Provider Information

NPI Number : 1912992496
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY W WAHL M.D.
Provider Business Mailing Address
First Line : 1045 KLOTZ RD
Second Line : PO BOX 738
City : BOWLING GREEN
State : OH
Zip : 43402-4820
Country : US
Telephone Number : 419-352-7588
Fax Number : 419-354-4977
Provider Business Practice Location Address
First Line : 1045 KLOTZ RD
Second Line :
City : BOWLING GREEN
State : OH
Zip : 43402-4820
Country : US
Telephone Number : 419-352-7588
Fax Number : 419-354-4977
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 01/20/2009

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