Provider Demographics
NPI:1215645809
Name:PAEZ, DOLORES LOURDES (MD)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:LOURDES
Last Name:PAEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 BALAYE VISTA CIR APT 301
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7602
Mailing Address - Country:US
Mailing Address - Phone:810-240-7340
Mailing Address - Fax:
Practice Address - Street 1:3010 E 138TH AVE STE 12
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3999
Practice Address - Country:US
Practice Address - Phone:813-975-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30030207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30030OtherHOUSE PHYSICIAN LICENSE