MEDICARE: DR. PAUL J WOTOWIC M.D.

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	208200000X	Plastic Surgery Physician	C42036	CA

General Provider Information

NPI Number	:	1821286022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL J WOTOWIC M.D.

Provider Business Mailing Address
First Line	:	5201 NORRIS CANYON RD
Second Line	:	SUITE 330
City	:	SAN RAMON
State	:	CA
Zip	:	94583-5411
Country	:	US
Telephone Number	:	925-866-6778
Fax Number	:	925-866-2902

Provider Business Practice Location Address
First Line	:	5201 NORRIS CANYON RD
Second Line	:	SUITE 330
City	:	SAN RAMON
State	:	CA
Zip	:	94583-5411
Country	:	US
Telephone Number	:	925-866-6778
Fax Number	:	925-866-2902

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

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	02/25/2008

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