Provider Demographics
NPI:1518905801
Name:PAUL, DEREK KAZIM (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:KAZIM
Last Name:PAUL
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 1:3735 11TH CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4844
Mailing Address - Country:US
Mailing Address - Phone:772-569-5660
Mailing Address - Fax:772-569-4343
Practice Address - Street 1:3735 11TH CIR
Practice Address - Street 2:STE 101
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4884
Practice Address - Country:US
Practice Address - Phone:772-569-5660
Practice Address - Fax:772-569-4343
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068650208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251102900Medicaid
FL31904Medicare ID - Type Unspecified
FL251102900Medicaid