Healthcare Provider Details

I. General information

NPI: 1861805962
Provider Name (Legal Business Name): PAUL MATTHEW DILLAWAY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9380 SW 150TH ST STE 230
MIAMI FL
33176-7947
US

IV. Provider business mailing address

8400 NW 33RD ST STE 201
DORAL FL
33122-1937
US

V. Phone/Fax

Practice location:
  • Phone: 844-665-4827
  • Fax:
Mailing address:
  • Phone: 844-665-4827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number006830
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: