Provider Demographics
NPI:1497790455
Name:PATRICK, JOHN T (MD, ANESTESIOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:PATRICK
Suffix:
Gender:M
Credentials:MD, ANESTESIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3788 HAROLD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7744
Mailing Address - Country:US
Mailing Address - Phone:239-931-9894
Mailing Address - Fax:239-542-0704
Practice Address - Street 1:4120 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7165
Practice Address - Country:US
Practice Address - Phone:239-542-2020
Practice Address - Fax:239-541-1492
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63832207L00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18772AMedicare ID - Type Unspecified
FLE37740Medicare UPIN