Provider Demographics
NPI:1649701343
Name:LAVOIE, PAUL MATHEW (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MATHEW
Last Name:LAVOIE
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 1:3598 S OCEAN BLVD
Mailing Address - Street 2:UNIT 5105
Mailing Address - City:HIGHLAND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3341
Mailing Address - Country:US
Mailing Address - Phone:561-674-2595
Mailing Address - Fax:
Practice Address - Street 1:3598 S OCEAN BLVD
Practice Address - Street 2:UNIT 5105
Practice Address - City:HIGHLAND BEACH
Practice Address - State:FL
Practice Address - Zip Code:33487-3341
Practice Address - Country:US
Practice Address - Phone:561-674-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009119207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program