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Organization
SANDUSKY FAMILY PRACTICE INC
Active
Organization
SANDUSKY FAMILY PRACTICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES JEFFERSON WYSOR MD (PHYSICIAN)
(419) 625-4461
Entity
Organization
Contact information
Practice address
3103 CAMPBELL ST, SANDUSKY, OH 44870-7230
(419) 625-4461
(419) 625-5199
Mailing address
3103 CAMPBELL ST, SANDUSKY, OH 44870-7230
(419) 625-4461
(419) 625-5199
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-047619
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000131843
ANTHEM
OH
01
—
04375
PARAMOUNT
OH
05
—
0538681
—
OH
01
—
20636020100
BWC
OH
01
—
206360201001
MED MUTUAL OF OHIO
OH
Enumeration date
11/10/2006
Last updated
08/22/2020
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