Provider Demographics
NPI:1871684944
Name:IZES, PAUL M (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:IZES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 2ND STREET PIKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-5902
Mailing Address - Country:US
Mailing Address - Phone:215-322-5575
Mailing Address - Fax:
Practice Address - Street 1:720 2ND STREET PIKE
Practice Address - Street 2:SUITE 105
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-5902
Practice Address - Country:US
Practice Address - Phone:215-322-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006987L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF29091Medicare UPIN
PA189882Medicare PIN