Provider Demographics
NPI:1124023569
Name:WAIBEL, PAUL C JR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:WAIBEL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4360 FULTON DR NW
Mailing Address - Street 2:STE B
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2824
Mailing Address - Country:US
Mailing Address - Phone:330-305-2020
Mailing Address - Fax:330-305-9090
Practice Address - Street 1:4360 FULTON DR NW
Practice Address - Street 2:STE B
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2824
Practice Address - Country:US
Practice Address - Phone:330-305-2020
Practice Address - Fax:330-305-9090
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35042118W207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0404572Medicaid
OH0404572Medicaid
WA0447673Medicare ID - Type Unspecified