Provider Demographics
NPI:1023167871
Name:PAUL, JOSE ELAVATH (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ELAVATH
Last Name:PAUL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:850 WILKINSON TRCE
Mailing Address - Street 2:APT 215
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-2488
Mailing Address - Country:US
Mailing Address - Phone:270-781-2489
Mailing Address - Fax:
Practice Address - Street 1:380 SUWANNEE TRAIL STREET
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103
Practice Address - Country:US
Practice Address - Phone:270-901-5000
Practice Address - Fax:270-842-6553
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYTP9102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY40628OtherSTATE LICENSE
KYFP0082494OtherDEA