Basic Information
| Provider Information | |||||||||
| NPI: | 1114922366 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAUTLER | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | EUGENE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12903 N 56TH ST | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336171225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138795795 | ||||||||
| FaxNumber: | 8138774578 | ||||||||
| Practice Location | |||||||||
| Address1: | 2705 W SAINT ISABEL ST | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138795795 | ||||||||
| FaxNumber: | 8138774578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2005 | ||||||||
| LastUpdateDate: | 07/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0107X | ME40175 | FL | N | 207W00000X | ME40175 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | P00283590 | 01 | FL | RAILROAD MEDICARE | OTHER |