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General NPI Number Information
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NPI Number | 1104847466
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Entity Type | Individual
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Provider Name | PATRICIA ISABEL MODAD M.D., F.A.C.O.G.
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Gender | Female
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 50 LEANNI WAY SUITES A3 & A4
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City | PALM COAST
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State | FL
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Zip | 32137-4751
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Country | US
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Telephone | 386-447-6831
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Fax | 386-447-6834
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Provider Business Mailing Address
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Address Line | P.O.BOX 351295
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City | PALM COAST
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State | FL
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Zip | 32137-1295
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Country | US
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Telephone | 386-447-6831
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Fax | 386-447-6834
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01053870A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME103310
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License Number State | FL
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