MEDICARE: PHILIP JAMES PAUSTIAN 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	207R00000X	Internal Medicine Physician	026615	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00377668	OTHER	GA	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	52047617022	OTHER	GA	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	14149	OTHER	FL	FL BCBS

General Provider Information

NPI Number	:	1215946850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP JAMES PAUSTIAN MD

Provider Business Mailing Address
First Line	:	PO BOX 15458
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32406-5458
Country	:	US
Telephone Number	:	850-228-5735
Fax Number	:

Provider Business Practice Location Address
First Line	:	20607 FRONT BEACH RD
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32413-3639
Country	:	US
Telephone Number	:	850-228-5735
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	12/19/2022

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