Provider Demographics
NPI:1366452377
Name:PAUKER, NEIL E (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:E
Last Name:PAUKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6801 PORTO FINO CIR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4390
Mailing Address - Country:US
Mailing Address - Phone:239-225-0874
Mailing Address - Fax:239-225-1465
Practice Address - Street 1:6801 PORTO FINO CIR
Practice Address - Street 2:SUITE #1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4390
Practice Address - Country:US
Practice Address - Phone:239-225-0874
Practice Address - Fax:239-225-1465
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME440442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
99721Medicare ID - Type Unspecified
FLD54506Medicare UPIN