Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | ME86337 | FL |
NPI | 1578598967 |
---|---|
Provider Name | Patrick J Demarco III |
First Address | Orange Park, FL 32073-4466 |
Second Address | Orange Park, FL 32073-4466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 25/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1811041015 | GROUP NPI (01) | FL |
I36178 | (02) | FL |
ME86337 | LICENSE NUMBER (01) | FL |