Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 79524 | OH |
Y | 207X00000X | Orthopaedic Surgeon | ME116721 | FL |
N | 207XS0117X | Orthopaedic Spine Surgeon | 79524 | OH |
NPI | 1215930912 |
---|---|
Provider Name | Mr. Paul J. Pagano |
First Address | St Petersburg, FL 33703-3802 |
Second Address | St Petersburg, FL 33703-3802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 26/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009475600 | (05) | FL |
341972661 | TAX ID (01) | OH |
79524 | LICENSE (01) | OH |
BP6662402 | DEA (01) | OH |
H14731 | (02) | OH |