MEDICARE: DR. PAULINO D DEOCAMPO 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	207RC0000X	Cardiovascular Disease Physician	25MA02340300	NJ

General Provider Information

NPI Number	:	1538137302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULINO D DEOCAMPO MD

Provider Business Mailing Address
First Line	:	1609 HUNTINGTON LN
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-5634
Country	:	US
Telephone Number	:	727-398-6661
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 HUNTINGTON LN
Second Line	:	S
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-5634
Country	:	US
Telephone Number	:	727-725-9315
Fax Number	:

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	07/08/2007

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