=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518905801
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEREK KAZIM PAUL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 06/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3735 11TH CIR STE 101
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-4884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-569-5660
-----------------------------------------------------
Fax | 772-569-4343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3735 11TH CIR SUITE 101
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-4844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-569-5660
-----------------------------------------------------
Fax | 772-569-4343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | ME0068650
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------