Provider Demographics
NPI:1982660023
Name:PANDOLFI, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:PANDOLFI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7552 NAVARRE PKWY
Mailing Address - Street 2:SUITE 10
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7305
Mailing Address - Country:US
Mailing Address - Phone:850-939-8474
Mailing Address - Fax:850-939-8475
Practice Address - Street 1:7552 NAVARRE PKWY
Practice Address - Street 2:SUITE 10
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7305
Practice Address - Country:US
Practice Address - Phone:850-939-8474
Practice Address - Fax:850-939-8475
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0056790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09622Medicare ID - Type Unspecified
FLC72674Medicare UPIN