Provider Demographics
NPI:1821286022
Name:WOTOWIC, PAUL J (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:WOTOWIC
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:5201 NORRIS CANYON RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5411
Mailing Address - Country:US
Mailing Address - Phone:925-866-6778
Mailing Address - Fax:925-866-2902
Practice Address - Street 1:5201 NORRIS CANYON RD
Practice Address - Street 2:SUITE 330
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5411
Practice Address - Country:US
Practice Address - Phone:925-866-6778
Practice Address - Fax:925-866-2902
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC42036208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE32513Medicare UPIN
CA00C420360Medicare PIN
CA00C420361Medicare PIN