Provider Demographics
NPI:1780613455
Name:ESPINOZA, PAUL MANUEL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MANUEL
Last Name:ESPINOZA
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 1:117 PARK PLACE CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-6690
Mailing Address - Country:US
Mailing Address - Phone:038-626-9075
Mailing Address - Fax:803-626-1105
Practice Address - Street 1:117 PARK PLACE CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-6690
Practice Address - Country:US
Practice Address - Phone:038-626-9075
Practice Address - Fax:803-626-1105
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20284207QA0505X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4726Medicaid
SC8752Medicare PIN
SCG742678752Medicare PIN
G74267Medicare UPIN