Healthcare Provider Details

I. General information

NPI: 1659578938
Provider Name (Legal Business Name): PAUL F FOTI, MD, FCCP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 PASADENA AVE S SUITE 480
SOUTH PASADENA FL
33707-4516
US

IV. Provider business mailing address

PO BOX 66405
ST PETERSBURG FL
33736-6405
US

V. Phone/Fax

Practice location:
  • Phone: 727-347-5242
  • Fax: 727-347-2402
Mailing address:
  • Phone: 727-347-5242
  • Fax: 727-347-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME61531
License Number StateFL

VIII. Authorized Official

Name: LAURIE L FOTI
Title or Position: OFFICE MANAGER
Credential:
Phone: 727-347-5242