Healthcare Provider Details

I. General information

NPI: 1043299985
Provider Name (Legal Business Name): PAULOS YOHANNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 VETERANS PARK DR STE 110
NAPLES FL
34109-0493
US

IV. Provider business mailing address

1845 VETERANS PARK DR STE 110
NAPLES FL
34109-0493
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-1160
  • Fax: 239-624-1161
Mailing address:
  • Phone: 239-624-1160
  • Fax: 239-624-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number21850
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME137408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: