Provider Demographics
NPI:1164430716
Name:WIZMAN, PAUL BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BERNARD
Last Name:WIZMAN
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 1:5800 COLONIAL DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5682
Mailing Address - Country:US
Mailing Address - Phone:954-969-1355
Mailing Address - Fax:954-969-1232
Practice Address - Street 1:5800 COLONIAL DR
Practice Address - Street 2:SUITE 108
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5682
Practice Address - Country:US
Practice Address - Phone:954-969-1355
Practice Address - Fax:954-969-1232
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70211174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG39082Medicare UPIN