Provider Demographics
NPI:1023204369
Name:PAUL ESPOSITO M.D. FACS PA
Entity Type:Organization
Organization Name:PAUL ESPOSITO M.D. FACS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ESPOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-730-3309
Mailing Address - Street 1:4900 W OAKLAND PARK BLVD
Mailing Address - Street 2:306
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-7500
Mailing Address - Country:US
Mailing Address - Phone:954-730-3309
Mailing Address - Fax:954-486-1079
Practice Address - Street 1:4900 W OAKLAND PARK BLVD
Practice Address - Street 2:306
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7500
Practice Address - Country:US
Practice Address - Phone:954-730-3309
Practice Address - Fax:954-486-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75181261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI806Medicare PIN
FLG72420Medicare UPIN