Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | ME14662 | FL |
NPI | 1023081759 |
---|---|
Provider Name | Dr. Tully C Patrowicz |
First Address | Eustis, FL 32726-5818 |
Second Address | Daytona Beach, FL 32114-1493 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D54319 | (02) | FL |