Healthcare Provider Details

I. General information

NPI: 1184041741
Provider Name (Legal Business Name): PAMELA SAULS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E ASH ST
PERRY FL
32347
US

IV. Provider business mailing address

390 S CENTRAL AVE
UMATILLA FL
32784-9602
US

V. Phone/Fax

Practice location:
  • Phone: 850-548-3278
  • Fax: 850-584-8171
Mailing address:
  • Phone: 352-669-3175
  • Fax: 352-669-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN615
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number018677
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME136957
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: