Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 0104000389 | VA |
NPI | 1013003516 |
---|---|
Provider Name | Dr. Patrick Raymond Patzer |
First Address | Virginia Beach, VA 23454-3111 |
Second Address | Virginia Beach, VA 23454-3111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T21961 | (02) | VA |