Provider Demographics
NPI:1821055328
Name:KOTTURAN, PAULSON (MD)
Entity Type:Individual
Prefix:
First Name:PAULSON
Middle Name:
Last Name:KOTTURAN
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 1:220 SW NATURA AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3026
Mailing Address - Country:US
Mailing Address - Phone:954-360-7000
Mailing Address - Fax:954-360-7511
Practice Address - Street 1:220 SW NATURA AVE
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3026
Practice Address - Country:US
Practice Address - Phone:954-360-7000
Practice Address - Fax:954-360-7511
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine