Provider Demographics
NPI:1790735777
Name:PAULET, FEDORA ESTHER (MD)
Entity Type:Individual
Prefix:DR
First Name:FEDORA
Middle Name:ESTHER
Last Name:PAULET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 E EXPRESSWAY 83
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-2741
Mailing Address - Country:US
Mailing Address - Phone:956-464-8600
Mailing Address - Fax:956-464-8601
Practice Address - Street 1:702 E EXPRESSWAY 83
Practice Address - Street 2:SUITE A-3
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-2741
Practice Address - Country:US
Practice Address - Phone:956-464-8600
Practice Address - Fax:956-464-8601
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM0219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177670003Medicaid
TX298993YTQ9OtherPTAN
TX8L4258Medicare PIN
TX177670003Medicaid