Healthcare Provider Details

I. General information

NPI: 1093793853
Provider Name (Legal Business Name): PAUL J. CIMOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S 23RD ST
FORT PIERCE FL
34950-4803
US

IV. Provider business mailing address

1700 S 23RD ST
FORT PIERCE FL
34950-4803
US

V. Phone/Fax

Practice location:
  • Phone: 714-206-6868
  • Fax: 772-468-4497
Mailing address:
  • Phone: 714-206-6868
  • Fax: 772-468-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME154455
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME154455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: