Provider Demographics
NPI:1265491286
Name:FLEURY, PAUL R (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:FLEURY
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 1:305 10TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:POCOMOKE
Mailing Address - State:MD
Mailing Address - Zip Code:21851-1607
Mailing Address - Country:US
Mailing Address - Phone:410-957-3005
Mailing Address - Fax:410-957-0550
Practice Address - Street 1:305 10TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:POCOMOKE
Practice Address - State:MD
Practice Address - Zip Code:21851-1607
Practice Address - Country:US
Practice Address - Phone:410-957-3005
Practice Address - Fax:410-957-0550
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD24870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD852691OtherMAMSI PROVIDER NO.
MDF094 0001OtherPROVIDER NO.
MD111719OtherCOVERNTRY PROVIDER NO.
VA114091OtherPROVIDER NO.
MD41361903OtherPROVIDER NO.
MD852691OtherMAMSI PROVIDER NO.