MEDICARE: SCOTT EUGENE PAUTLER MD

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	207WX0107X	Retina Specialist (Ophthalmology) Physician	ME40175	FL
2	207W00000X	Ophthalmology Physician	ME40175	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00283590	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1114922366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT EUGENE PAUTLER MD

Provider Business Mailing Address
First Line	:	12903 N 56TH ST
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-1225
Country	:	US
Telephone Number	:	813-879-5795
Fax Number	:	813-877-4578

Provider Business Practice Location Address
First Line	:	2705 W SAINT ISABEL ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6319
Country	:	US
Telephone Number	:	813-879-5795
Fax Number	:	813-877-4578

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/17/2020

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Directions to “ SCOTT EUGENE PAUTLER MD” Practice Location

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