Healthcare Provider Details

I. General information

NPI: 1700876877
Provider Name (Legal Business Name): ANDRES PATRON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10796 PINES BLVD SUITE #205
PEMBROKE PINES FL
33026-3919
US

IV. Provider business mailing address

10796 PINES BLVD SUITE #205
PEMBROKE PINES FL
33026-3919
US

V. Phone/Fax

Practice location:
  • Phone: 954-885-5555
  • Fax: 954-885-5333
Mailing address:
  • Phone: 954-885-5555
  • Fax: 954-885-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS6273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: