Provider Demographics
NPI:1407820426
Name:PAULSON, JEFFERY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:WAYNE
Last Name:PAULSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:618 SHADOW TREE DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-7419
Mailing Address - Country:US
Mailing Address - Phone:760-443-5621
Mailing Address - Fax:
Practice Address - Street 1:FLEET FORCES COMMAND
Practice Address - Street 2:1562 MITSCHER AVE, STE 250
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23551-0001
Practice Address - Country:US
Practice Address - Phone:757-836-0106
Practice Address - Fax:757-836-5499
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG63842207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine