Provider Demographics
NPI:1609975325
Name:PAUL D. WETZEL, M.D. INC
Entity Type:Organization
Organization Name:PAUL D. WETZEL, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:WETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-215-9594
Mailing Address - Street 1:1551 BISHOP ST STE 430
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4663
Mailing Address - Country:US
Mailing Address - Phone:805-261-1044
Mailing Address - Fax:805-250-7452
Practice Address - Street 1:1551 BISHOP ST STE 430
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4663
Practice Address - Country:US
Practice Address - Phone:805-261-1044
Practice Address - Fax:805-250-7452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA71477BOtherPPIN
CAW19472Medicare PIN
CAWA71477BOtherPPIN