Provider Demographics
NPI:1194726257
Name:WEOTT, PAUL CHRISTOPHER (CPO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:CHRISTOPHER
Last Name:WEOTT
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13516 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-2742
Mailing Address - Country:US
Mailing Address - Phone:727-327-3332
Mailing Address - Fax:727-327-7304
Practice Address - Street 1:3611 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7503
Practice Address - Country:US
Practice Address - Phone:727-327-3332
Practice Address - Fax:727-327-7304
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0589050001Medicare ID - Type Unspecified