Provider Demographics
NPI:1700873908
Name:PAUL, PHILIP
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 S DIXIE HWY STE 320
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-6530
Mailing Address - Country:US
Mailing Address - Phone:305-253-5585
Mailing Address - Fax:305-253-5679
Practice Address - Street 1:13101 S DIXIE HWY STE 320
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156
Practice Address - Country:US
Practice Address - Phone:305-253-5585
Practice Address - Fax:305-253-5679
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0020383208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL205003OtherAVMED
FL375790100Medicaid
FL92133OtherBCBS