Provider Demographics
NPI:1568411551
Name:PASCO, PATRICK J (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:PASCO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:360 SIMPSON HIGHWAY 149
Mailing Address - Street 2:SUITE 380
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-3841
Mailing Address - Country:US
Mailing Address - Phone:601-849-1215
Mailing Address - Fax:601-849-5320
Practice Address - Street 1:360 SIMPSON HIGHWAY 149
Practice Address - Street 2:SUITE 380
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3841
Practice Address - Country:US
Practice Address - Phone:601-849-1215
Practice Address - Fax:601-849-5320
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2011-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS07510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123453Medicaid
MS00123453Medicaid
MSD08004Medicare UPIN