Provider Demographics
NPI:1326078809
Name:WOLOSZYN, PATRICK F (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:F
Last Name:WOLOSZYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9128 220TH ST
Mailing Address - Street 2:
Mailing Address - City:O BRIEN
Mailing Address - State:FL
Mailing Address - Zip Code:32071-3229
Mailing Address - Country:US
Mailing Address - Phone:386-935-0288
Mailing Address - Fax:
Practice Address - Street 1:9128 220TH ST
Practice Address - Street 2:
Practice Address - City:O BRIEN
Practice Address - State:FL
Practice Address - Zip Code:32071-3229
Practice Address - Country:US
Practice Address - Phone:386-935-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27045OtherBCBS
FL3785203Medicaid
FL3785203Medicaid
FLB27656Medicare UPIN