Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | DN21483 | FL |
N | 213EG0000X | General Practice | DN21483 | FL |
N | 1223P0106X | Oral and Maxillofacial Pathology | 5530 | AL |
N | 1223P0106X | Oral and Maxillofacial Pathology | DN21483 | FL |
NPI | 1669568861 |
---|---|
Provider Name | Patricia Devilliers |
First Address | Bradenton, FL 34212-5577 |
Second Address | Bradenton, FL 34212-5577 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009939299 | (05) | AL |
009939328 | (05) | AL |
051537040 | BCBS (01) | AL |
051537044 | BCBS (01) | AL |
051537045 | BCBS (01) | AL |
P00373688 | RAILROAD MEDICARE (01) |