Provider Demographics
NPI:1043210313
Name:WEHRMEYER, JOEL T (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:T
Last Name:WEHRMEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S PLUM ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1630
Mailing Address - Country:US
Mailing Address - Phone:937-644-1920
Mailing Address - Fax:937-644-2024
Practice Address - Street 1:6251 GOOD SAMARITAN WAY STE 210C
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-5464
Practice Address - Country:US
Practice Address - Phone:937-233-3910
Practice Address - Fax:937-233-8389
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-083181208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2433058Medicaid
I16855Medicare UPIN