Provider Demographics
NPI:1558479493
Name:PATTY, JAMES WALTER (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WALTER
Last Name:PATTY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1401 CENTERVILLE RD
Mailing Address - Street 2:SUITE 404A
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-878-7151
Mailing Address - Fax:850-656-2255
Practice Address - Street 1:1401 CENTERVILLE RD
Practice Address - Street 2:SUITE 404A
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-878-7151
Practice Address - Fax:850-656-1086
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME19973207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D54563Medicare UPIN