Provider Demographics
NPI:1649245036
Name:BRETTON, PAUL R (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:BRETTON
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-2030
Mailing Address - Fax:239-343-4116
Practice Address - Street 1:507 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2618
Practice Address - Country:US
Practice Address - Phone:239-772-0500
Practice Address - Fax:239-772-3076
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057549208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL243136OtherAVMED PROVIDER NUMBER
FL739834OtherFIRST HLTH/CCN PROVIDER #
FL1192948OtherWELLCARE
FL4199976OtherAETNA PROVIDER NUMBER
FL0627067-005OtherCIGNA PROVIDER NUMBER
FL215252OtherAMERIGROUP PROVIDER NUM.
FLME0057549OtherMETCARE PROVIDER NUMBER
FL10507OtherBCBS PROVIDER NUMBER
FL063616900Medicaid
FL285158OtherUSA MNGD. CR. PROVIDER #
FL77074OtherOP. ENGIN. PROVIDER #
FL4199976OtherAETNA PROVIDER NUMBER
FL243136OtherAVMED PROVIDER NUMBER