MEDICARE: DR. PANAGIOTIS PAULUS M.D.

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	207W00000X	Ophthalmology Physician	R6D36	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180034174	OTHER	MO	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	123992	OTHER		BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578533030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PANAGIOTIS PAULUS M.D.

Provider Business Mailing Address
First Line	:	2210 BARRON RD
Second Line	:	SUITE 114
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-1908
Country	:	US
Telephone Number	:	573-686-4800
Fax Number	:	573-686-8448

Provider Business Practice Location Address
First Line	:	2210 BARRON RD
Second Line	:	SUITE 114
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-1908
Country	:	US
Telephone Number	:	573-686-4800
Fax Number	:	573-686-8448

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. PANAGIOTIS PAULUS M.D.” Practice Location

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