Provider Demographics
NPI:1699855841
Name:LIZOTTE, PAUL EDWARD (DO)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:EDWARD
Last Name:LIZOTTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 NORTH EL CAMINO REAL SUITE A
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1844
Mailing Address - Country:US
Mailing Address - Phone:760-330-5055
Mailing Address - Fax:760-542-2026
Practice Address - Street 1:115 NORTH EL CAMINO REAL SUITE A
Practice Address - Street 2:115 NORTH EL CAMINO REAL SUITE A
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1844
Practice Address - Country:US
Practice Address - Phone:760-330-5055
Practice Address - Fax:760-542-2026
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6147207U00000X, 207R00000X, 207U00000X
CA0000020A61472085R0202X, 2085R0202X
MI5101012192207U00000X, 2085R0202X
OH34.010618207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA127512OtherMEDICARE PTAN