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General NPI Number Information
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NPI Number | 1093011660
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Entity Type | Organization
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Legal Business Name | P.K.PAUL,M.D. PA
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Dates
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Enumeration Date | 01/31/2011
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Last Update Date | 01/31/2011
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Provider Practice Location Address
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Address Line | 705 HARVARD ST
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City | BROOKSVILLE
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State | FL
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Zip | 34601-2842
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Country | US
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Telephone | 352-799-3555
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Fax | 352-799-9299
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Provider Business Mailing Address
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Address Line | 705 HARVARD ST
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City | BROOKSVILLE
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State | FL
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Zip | 34601-2842
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Country | US
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Telephone | 352-799-3555
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Fax | 352-799-9299
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PUDICHERY K PAUL
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Credential | M.D.
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Telephone | 352-799-3555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0037402
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License Number State | FL
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