Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 8501 | SD |
NPI | 1003040296 |
---|---|
Provider Name | Dr. Jorge E Patino-Buelvas |
First Address | Sioux Falls, SD 57117-5046 |
Second Address | Sioux Falls, SD 57105-1305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2009 |
Last Update Date | 30/01/2014 |