Individual
PAUL LOUIS WASSERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
60 MEMORIAL MEDICAL PKWY, PALM COAST, FL 32164-5980
(386) 586-2000
(317) 705-5047
Mailing address
60 MEMORIAL MEDICAL PKWY, PALM COAST, FL 32164-5980
(386) 586-2000
(317) 705-5047
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
2004-00278
NC
2085B0100X
Body Imaging Physician
OS1113
FL
2085R0202X
Diagnostic Radiology Physician
2004-00278
NC
2085R0202X
Diagnostic Radiology Physician
Primary
OS11113
FL
2085R0204X
Vascular & Interventional Radiology Physician
2004-00278
NC
2085R0204X
Vascular & Interventional Radiology Physician
OS11113
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139NM
BCBS
—
01
—
189353
MEDCOST
—
01
—
2038722D
MEDICARE
NC
05
—
3810008229
—
WV
05
—
5901625
—
NC
01
—
7547722
AETNA
—
01
—
805973
PARTNERS
—
01
—
P00367349
RR MEDICARE
—
05
—
Q0027M
—
SC
Enumeration date
06/25/2006
Last updated
09/07/2022
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us