Basic Information
| Provider Information | |||||||||
| NPI: | 1487650271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIREBAUGH | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | FRANK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 702 COMMERCE DR | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435515239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198727600 | ||||||||
| FaxNumber: | 4198727601 | ||||||||
| Practice Location | |||||||||
| Address1: | 702 COMMERCE DR | ||||||||
| Address2: | STE 160 | ||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435515271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198727600 | ||||||||
| FaxNumber: | 4198727601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2005 | ||||||||
| LastUpdateDate: | 02/15/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35-050638 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0597591 | 05 | OH | MEDICAID |