MEDICARE: DR. MARCUS E. PAUL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7742	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	781936	OTHER		DELTA DENTAL PROVIDER NUM
2	40817	OTHER	FL	ATLANTIC DENTAL PROVIDER
3	781936	OTHER		UNITED CONCORDIA PROVIDER
4	86824	OTHER		BLUESHIELD PROVIDER NUMBE

General Provider Information

NPI Number	:	1013910579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCUS E. PAUL DMD

Provider Business Mailing Address
First Line	:	555 BRENT LN
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2044
Country	:	US
Telephone Number	:	850-474-0449
Fax Number	:	866-627-2715

Provider Business Practice Location Address
First Line	:	555 BRENT LN
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2044
Country	:	US
Telephone Number	:	850-474-0449
Fax Number	:	866-627-2715

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/09/2007

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