MEDICARE: DR. IVANA PAZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME147992	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME147992	OTHER	FL	FL DOH

General Provider Information

NPI Number	:	1346474632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVANA PAZ MD

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2612

Provider Business Practice Location Address
First Line	:	6615 HILLWAY CIR STE 201
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34112-8755
Country	:	US
Telephone Number	:	239-315-7541
Fax Number	:	239-315-7542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2009
Last Update Date	:	02/16/2023

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