Provider Demographics
NPI:1528056595
Name:PAUL, DAVID BRIAN (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRIAN
Last Name:PAUL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:15620 EDGEWOOD DR
Mailing Address - Street 2:STE 200
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-6983
Mailing Address - Country:US
Mailing Address - Phone:218-330-6999
Mailing Address - Fax:218-825-8027
Practice Address - Street 1:15620 EDGEWOOD DR
Practice Address - Street 2:STE 200
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-6983
Practice Address - Country:US
Practice Address - Phone:218-330-6999
Practice Address - Fax:218-825-8027
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2013-09-04
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Provider Licenses
StateLicense IDTaxonomies
MN27775208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN905867200Medicaid
A01349Medicare UPIN
MN340001294Medicare PIN
MN905867200Medicaid