Provider Demographics
NPI:1295792489
Name:KOUNTZ, PAUL D JR (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:KOUNTZ
Suffix:JR
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:PO BOX 678207
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8207
Mailing Address - Country:US
Mailing Address - Phone:800-841-4236
Mailing Address - Fax:706-653-1162
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6522
Practice Address - Fax:888-972-8644
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC157882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC157886Medicaid
NC5903029Medicaid
SC157886Medicaid
SCE89577Medicare UPIN
SCE895777895Medicare PIN
SCE895771324Medicare PIN
SCP00214894Medicare PIN