Provider Demographics
NPI:1053342550
Name:TARTELL, PAUL BRENDEN (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:BRENDEN
Last Name:TARTELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 NW 82ND AVE
Mailing Address - Street 2:SUITE# 104
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7809
Mailing Address - Country:US
Mailing Address - Phone:954-236-0200
Mailing Address - Fax:
Practice Address - Street 1:100 NW 82ND AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7809
Practice Address - Country:US
Practice Address - Phone:954-236-0200
Practice Address - Fax:954-474-3405
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62877207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24526OtherVISTA OF SOUTH FLORIDA
FL650799846OtherBEECHSTREET
FL25711OtherBLUE CROSS BLUE SHIELD
FL3240OtherTOTAL HEALTH CHOICE
FL4118OtherDIMENSIONS
FL650799846OtherPREFERRED HEALTH NETWORK
FL76701105OtherCIGNA
FL005317OtherNEIGHBORHOOD HEALTH
FL650799846OtherSOUTHCARE
FL0699458OtherGHI
FL377750200Medicaid
FL510990OtherAETNA
FL740200OtherFIRST HEALTH PPO
FL40011790OtherRAILROAD MEDICARE
FL25711OtherBLUE CROSS BLUE SHIELD
FL650799846OtherBEECHSTREET