MEDICARE: MR. PAUL FREDRICK SPECKART MD, M.F.A.C.P.

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	C31776	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	92585978	OTHER	CA	CHAMPUS
2	C31776	OTHER	CA	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	31776	OTHER	CA	HMO
5	00C317660	OTHER	CA	BLUE SHIELD
6	C31776	OTHER	CA	PPO/COMM

General Provider Information

NPI Number	:	1447346192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL FREDRICK SPECKART MD, M.F.A.C.P.

Provider Business Mailing Address
First Line	:	1102 HUNTER ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1323
Country	:	US
Telephone Number	:	619-293-3021
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 3RD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5616
Country	:	US
Telephone Number	:	619-297-3737
Fax Number	:	619-297-0443

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	02/01/2012

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Directions to “ MR. PAUL FREDRICK SPECKART MD, M.F.A.C.P.” Practice Location

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