Provider Demographics
NPI:1902852148
Name:PAUL, BOBBY W (MD)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:W
Last Name:PAUL
Suffix:
Gender:F
Credentials:MD
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 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:1440 ROCKSIDE RD STE 101
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2749
Practice Address - Country:US
Practice Address - Phone:216-749-8277
Practice Address - Fax:216-749-8273
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-063082207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000665745OtherANTHEM
OH4411484OtherAETNA
OHP63082OtherSUMMACARE
OH0889089Medicaid
OH000000665745OtherANTHEM
OH0889089Medicaid
OHP00737783Medicare PIN