Provider Demographics
NPI:1114381118
Name:PAULTRE, KRISTOPHER JACQUES (MD)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:JACQUES
Last Name:PAULTRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 SW 1ST AVE APT 2620
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-5408
Mailing Address - Country:US
Mailing Address - Phone:954-732-8726
Mailing Address - Fax:
Practice Address - Street 1:13707 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1106
Practice Address - Country:US
Practice Address - Phone:305-585-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137411207Q00000X, 207XX0005X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program