Provider Demographics
NPI:1487650271
Name:WIREBAUGH, JEFFREY FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:FRANK
Last Name:WIREBAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:702 COMMERCE DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5239
Mailing Address - Country:US
Mailing Address - Phone:419-872-7600
Mailing Address - Fax:419-872-7601
Practice Address - Street 1:702 COMMERCE DR
Practice Address - Street 2:STE 160
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5271
Practice Address - Country:US
Practice Address - Phone:419-872-7600
Practice Address - Fax:419-872-7601
Is Sole Proprietor?:No
Enumeration Date:2005-06-26
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-050638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0597591Medicaid
OHWI0570145Medicare ID - Type Unspecified
OH0597591Medicaid