Provider Demographics
NPI:1184680985
Name:DILLAHUNT, PAUL H II (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:H
Last Name:DILLAHUNT
Suffix:II
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:PO BOX 43667
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-3667
Mailing Address - Country:US
Mailing Address - Phone:904-398-3760
Mailing Address - Fax:904-389-2480
Practice Address - Street 1:820 PRUDENTIAL DR STE 112
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8204
Practice Address - Country:US
Practice Address - Phone:904-396-5996
Practice Address - Fax:904-389-2480
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME23103207RC0000X, 207U00000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036771100Medicaid
DE16990RMedicare PIN
FL036771100Medicaid