Healthcare Provider Details

I. General information

NPI: 1710309919
Provider Name (Legal Business Name): MR. PATRICK TIMOTHY MALONEY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 W STATE ST
COLUMBUS OH
43222-1551
US

IV. Provider business mailing address

793 W STATE ST
COLUMBUS OH
43222-1551
US

V. Phone/Fax

Practice location:
  • Phone: 850-503-6274
  • Fax:
Mailing address:
  • Phone: 850-503-6274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9278575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: