Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 4301096370 | MI |
Y | 207L00000X | Anesthesiologist | ME119553 | FL |
NPI | 1013247626 |
---|---|
Provider Name | Patrick C. Fattouch |
First Address | Maitland, FL 32751-7406 |
Second Address | Maitland, FL 32751-7406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2010 |
Last Update Date | 10/01/2018 |