Healthcare Provider Details

I. General information

NPI: 1962721944
Provider Name (Legal Business Name): RAUL PAEZ, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2010
Last Update Date: 05/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 COLLEGE AVE
CLEMSON SC
29631-1432
US

IV. Provider business mailing address

398 COLLEGE AVE
CLEMSON SC
29631-1432
US

V. Phone/Fax

Practice location:
  • Phone: 864-653-4112
  • Fax:
Mailing address:
  • Phone: 864-653-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13816
License Number StateSC

VIII. Authorized Official

Name: DR. RAUL PAEZ
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 800-650-6334