Healthcare Provider Details

I. General information

NPI: 1740544923
Provider Name (Legal Business Name): PATRICK BRANDON VICKERS D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 N BEAVER ST STE 203
FLAGSTAFF AZ
86001-3120
US

IV. Provider business mailing address

150 SE 17TH ST STE 501
OCALA FL
34471-5176
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-2200
  • Fax:
Mailing address:
  • Phone: 434-799-3859
  • Fax: 434-773-6803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number011591
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0102203852
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberOS15017
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number25MB10490600
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberOP70020997
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2828
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberOS017570
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01919
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: