Healthcare Provider Details

I. General information

NPI: 1558360479
Provider Name (Legal Business Name): PATRICK DEVLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SONOMA AVE SUITE 302
SANTA ROSA CA
95405-4819
US

IV. Provider business mailing address

1111 SONOMA AVE SUITE 302
SANTA ROSA CA
95405-4819
US

V. Phone/Fax

Practice location:
  • Phone: 707-545-7300
  • Fax: 707-545-7333
Mailing address:
  • Phone: 707-545-7300
  • Fax: 707-545-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG56533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: