Healthcare Provider Details

I. General information

NPI: 1568411551
Provider Name (Legal Business Name): PATRICK J. PASCO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SIMPSON HIGHWAY 149 SUITE 380
MAGEE MS
39111-3841
US

IV. Provider business mailing address

360 SIMPSON HIGHWAY 149 SUITE 380
MAGEE MS
39111-3841
US

V. Phone/Fax

Practice location:
  • Phone: 601-849-1215
  • Fax: 601-849-5320
Mailing address:
  • Phone: 601-849-1215
  • Fax: 601-849-5320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number07510
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: