Provider Demographics
NPI:1215158092
Name:ESPY, PAUL GOODMAN (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:GOODMAN
Last Name:ESPY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 848491
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8491
Mailing Address - Country:US
Mailing Address - Phone:254-202-9330
Mailing Address - Fax:254-202-9349
Practice Address - Street 1:50 HILLCREST MEDICAL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8953
Practice Address - Country:US
Practice Address - Phone:254-202-7900
Practice Address - Fax:254-202-7949
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA059150208800000X
TXR4218208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00743846Medicare PIN