Provider Demographics
NPI:1770577173
Name:HOROVITZ, PAUL MYRON (DPM)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MYRON
Last Name:HOROVITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 STEPHENSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5931
Mailing Address - Country:US
Mailing Address - Phone:912-352-7437
Mailing Address - Fax:912-352-2482
Practice Address - Street 1:325 STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5931
Practice Address - Country:US
Practice Address - Phone:912-352-7437
Practice Address - Fax:912-352-2482
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000627213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GPD627OtherMA SC
GA00455188AMedicaid
GPD627OtherMA SC
U13520Medicare UPIN