Provider Demographics
NPI:1669430088
Name:JO, PAUL D (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:JO
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 1:2301 SE 3RD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5105
Mailing Address - Country:US
Mailing Address - Phone:352-351-0029
Mailing Address - Fax:352-840-9977
Practice Address - Street 1:2301 SE 3RD AVE
Practice Address - Street 2:BLDG. 100, SUITE A
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-351-0029
Practice Address - Fax:352-840-9977
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72987174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41710YMedicare PIN
FLF92113Medicare UPIN