Provider Demographics
NPI:1215946850
Name:PAUSTIAN, PHILIP JAMES (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:JAMES
Last Name:PAUSTIAN
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:PO BOX 15458
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-5458
Mailing Address - Country:US
Mailing Address - Phone:850-228-5735
Mailing Address - Fax:
Practice Address - Street 1:20607 FRONT BEACH RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-3639
Practice Address - Country:US
Practice Address - Phone:850-228-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026615207R00000X
FLME45564208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00377668OtherRAIL ROAD MEDICARE
GA52047617022OtherBCBS
GA427196341AMedicaid
FL001371200Medicaid
FL14149OtherFL BCBS
GAP00377668OtherRAIL ROAD MEDICARE
FL14149ZMedicare PIN