Provider Demographics
NPI:1669442810
Name:DOWDY, PAUL A (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:DOWDY
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 1:105 PARK PLACE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-6858
Mailing Address - Country:US
Mailing Address - Phone:863-421-7411
Mailing Address - Fax:863-547-9514
Practice Address - Street 1:105 PARK PLACE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-6858
Practice Address - Country:US
Practice Address - Phone:863-421-7411
Practice Address - Fax:863-547-9514
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-10-28
Deactivation Date:2018-11-04
Deactivation Code:
Reactivation Date:2020-10-28
Provider Licenses
StateLicense IDTaxonomies
FLME 72924207XX0005X, 207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
200041017OtherRAILROAD MEDICARE
FL252802900Medicaid
45061OtherBCBS PROVIDER #
G58599Medicare UPIN
FL252802900Medicaid
FL45061ZMedicare ID - Type Unspecified