Healthcare Provider Details

I. General information

NPI: 1043283583
Provider Name (Legal Business Name): PAUL JOSEPH DEMIERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL SUPPORT ACTIVITY SOUDA BAY MOUZOURAS AKROTIRIOU
CHANIA CRETE
73100
GR

IV. Provider business mailing address

PSC 814 BOX 19
FPO AE
09266-0001
US

V. Phone/Fax

Practice location:
  • Phone: 282-102-1590
  • Fax:
Mailing address:
  • Phone: 808-754-9695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number040654
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: