Provider Demographics
NPI:1053317784
Name:PAULET, JUAN (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:PAULET
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 1:725 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45435-0001
Mailing Address - Country:US
Mailing Address - Phone:937-245-7100
Mailing Address - Fax:937-245-7999
Practice Address - Street 1:5 W WENGER RD
Practice Address - Street 2:STE D
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2723
Practice Address - Country:US
Practice Address - Phone:937-275-8900
Practice Address - Fax:937-276-0534
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-3244-P207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000280745OtherANTHEM BENEFIT ADMINISTRA
OH000000280745OtherBCBS-OH (ANTHEM)
OH311417673030OtherCARESOURCE
OHPO0133785OtherRAILROAD MEDICARE-PALMETT
OHD3324404OtherCHOICECARE
OH311417673OtherCHAMPUS/TRICARE (WPS)
OH4032122OtherAETNA US HEALTHCARE
OHD3324404OtherCHOICECARE
OHD3324404OtherCHOICECARE
OH311417673OtherCHAMPUS/TRICARE (WPS)
OHPA0400034Medicare PIN