Provider Demographics
NPI:1902963788
Name:SOUTHARD, PAUL K (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:K
Last Name:SOUTHARD
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 1:10090 SUNBURST CT
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-2649
Mailing Address - Country:US
Mailing Address - Phone:352-683-3493
Mailing Address - Fax:
Practice Address - Street 1:10730 STATE ROAD 54 STE 104
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-2265
Practice Address - Country:US
Practice Address - Phone:727-372-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine