Healthcare Provider Details

I. General information

NPI: 1578598967
Provider Name (Legal Business Name): PATRICK J DEMARCO III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 KINGSLEY AVE SUITE 401
ORANGE PARK FL
32073-4466
US

IV. Provider business mailing address

1895 KINGSLEY AVE SUITE 401
ORANGE PARK FL
32073-4466
US

V. Phone/Fax

Practice location:
  • Phone: 904-272-5251
  • Fax: 904-276-0459
Mailing address:
  • Phone: 904-272-5251
  • Fax: 904-276-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME86337
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: