Individual
EDWARD G PAUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2920 N 4TH ST, FLAGSTAFF, AZ 86004
(928) 522-9400
(928) 774-4808
Mailing address
PO BOX 3630, FLAGSTAFF, AZ 86003-3630
(928) 522-9400
(928) 774-4808
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33100
AZ
208M00000X
Hospitalist Physician
33100
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276776
—
AZ
01
—
Z145397
MEDICARE PTAN
AZ
Enumeration date
10/17/2006
Last updated
08/29/2019
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