Provider Demographics
NPI:1487664124
Name:BASILE, PATRICK LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:LOUIS
Last Name:BASILE
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 1:3316 3RD ST S STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6090
Mailing Address - Country:US
Mailing Address - Phone:904-222-6262
Mailing Address - Fax:
Practice Address - Street 1:3316 3RD ST S STE 104
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6090
Practice Address - Country:US
Practice Address - Phone:904-222-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120272208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery