Provider Demographics
NPI:1114922366
Name:PAUTLER, SCOTT EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:EUGENE
Last Name:PAUTLER
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 1:12903 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1225
Mailing Address - Country:US
Mailing Address - Phone:813-879-5795
Mailing Address - Fax:813-877-4578
Practice Address - Street 1:2705 W SAINT ISABEL ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6319
Practice Address - Country:US
Practice Address - Phone:813-879-5795
Practice Address - Fax:813-877-4578
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40175207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00283590OtherRAILROAD MEDICARE
D77527Medicare UPIN
FL30879ZMedicare PIN
FL30879YMedicare PIN
FLP00283590OtherRAILROAD MEDICARE
FL30879Medicare PIN