Healthcare Provider Details

I. General information

NPI: 1164430716
Provider Name (Legal Business Name): PAUL BERNARD WIZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9960 CENTRAL PARK BLVD N STE 235
BOCA RATON FL
33428-1760
US

IV. Provider business mailing address

9960 CENTRAL PARK BLVD N STE 235
BOCA RATON FL
33428-1760
US

V. Phone/Fax

Practice location:
  • Phone: 954-969-1355
  • Fax: 954-969-1232
Mailing address:
  • Phone: 954-969-1355
  • Fax: 954-969-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME70211
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME70211
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: