MEDICARE: PAUL J PANDOLFI 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	207Q00000X	Family Medicine Physician	ME0056790	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982660023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL J PANDOLFI M.D.

Provider Business Mailing Address
First Line	:	7552 NAVARRE PKWY
Second Line	:	SUITE 10
City	:	NAVARRE
State	:	FL
Zip	:	32566-7305
Country	:	US
Telephone Number	:	850-939-8474
Fax Number	:	850-939-8475

Provider Business Practice Location Address
First Line	:	7552 NAVARRE PKWY
Second Line	:	SUITE 10
City	:	NAVARRE
State	:	FL
Zip	:	32566-7305
Country	:	US
Telephone Number	:	850-939-8474
Fax Number	:	850-939-8475

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/06/2010

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