Provider Demographics
NPI:1225158884
Name:PATRICK G DEVLIN MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PATRICK G DEVLIN MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:DEVLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-545-7300
Mailing Address - Street 1:1111 SONOMA AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4819
Mailing Address - Country:US
Mailing Address - Phone:707-545-7300
Mailing Address - Fax:707-545-7333
Practice Address - Street 1:1111 SONOMA AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4819
Practice Address - Country:US
Practice Address - Phone:707-545-7300
Practice Address - Fax:707-545-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56533174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ27903ZMedicare ID - Type Unspecified
CAE04648Medicare UPIN