Provider Demographics
NPI:1184041741
Name:SAULS, PAMELA (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:SAULS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-9602
Mailing Address - Country:US
Mailing Address - Phone:352-669-3175
Mailing Address - Fax:352-669-3640
Practice Address - Street 1:315 E ASH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347
Practice Address - Country:US
Practice Address - Phone:850-548-3278
Practice Address - Fax:850-584-8171
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN615208D00000X
PR018677208D00000X
FLME136957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015385800Medicaid
FL151RZOtherFLORIDA BLUE
FL015385800Medicaid