Provider Demographics
NPI:1043299985
Name:YOHANNES, PAULOS (MD)
Entity Type:Individual
Prefix:
First Name:PAULOS
Middle Name:
Last Name:YOHANNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 VETERANS PARK DR STE 110
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0493
Mailing Address - Country:US
Mailing Address - Phone:239-624-1160
Mailing Address - Fax:239-624-1161
Practice Address - Street 1:1845 VETERANS PARK DR STE 110
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0493
Practice Address - Country:US
Practice Address - Phone:239-624-1160
Practice Address - Fax:239-624-1161
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21850208800000X
FLME137408208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100552400Medicaid
FLJM084OtherMEDICARE
FLV57EMOtherBCBS