Provider Demographics
NPI:1659362176
Name:WESSON, PAUL DAVID II (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:WESSON
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-0418
Mailing Address - Country:US
Mailing Address - Phone:419-675-1962
Mailing Address - Fax:419-673-8058
Practice Address - Street 1:75 WASHINGTON BLVD
Practice Address - Street 2:#101
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-4001
Practice Address - Country:US
Practice Address - Phone:419-675-1962
Practice Address - Fax:419-673-8058
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0174289Medicaid
OH0174289Medicaid
OH4106952Medicare ID - Type Unspecified