Provider Demographics
NPI:1619953742
Name:OPSAHL, PAUL J (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:OPSAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2912 SPRINGBORO W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:513-897-0085
Mailing Address - Fax:513-897-0194
Practice Address - Street 1:4353 E STATE ROUTE 73 STE 120
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068-8814
Practice Address - Country:US
Practice Address - Phone:513-897-0085
Practice Address - Fax:513-897-0194
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35047593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000227901OtherUNICARE
OH080188829OtherRAILROAD MEDICARE
35047593OtherMEDICAL LICENSE
OH0527497Medicaid
OH421534506034OtherCARESOURCE
ND634298OtherAETNA
OHOC05219OtherNATIONWIDE
ND0120625OtherUNITED HEALTH CARE
OH000000227901OtherANTHEM
OH4759302OtherHUMANA/CHOICECARE
OHOC05219OtherNATIONWIDE
OH080188829OtherRAILROAD MEDICARE