Healthcare Provider Details

I. General information

NPI: 1114922366
Provider Name (Legal Business Name): SCOTT EUGENE PAUTLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 W SAINT ISABEL ST
TAMPA FL
33607-6319
US

IV. Provider business mailing address

12903 N 56TH ST
TEMPLE TERRACE FL
33617-1225
US

V. Phone/Fax

Practice location:
  • Phone: 813-879-5795
  • Fax: 813-877-4578
Mailing address:
  • Phone: 813-879-5795
  • Fax: 813-877-4578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME40175
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME40175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: