Provider Demographics
NPI:1336468198
Name:PAUL, JOANNES J A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNES
Middle Name:J A
Last Name:PAUL
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 1:1601 CLINT MOORE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2768
Mailing Address - Country:US
Mailing Address - Phone:561-939-0300
Mailing Address - Fax:561-939-0339
Practice Address - Street 1:1601 CLINT MOORE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2768
Practice Address - Country:US
Practice Address - Phone:561-939-0300
Practice Address - Fax:561-939-0339
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1228832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99446OtherMEDICARE GROUP NUMBER
FLIE138ZMedicare PIN