Provider Demographics
NPI:1578598967
Name:DEMARCO, PATRICK J III (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:DEMARCO
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1895 KINGSLEY AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4466
Mailing Address - Country:US
Mailing Address - Phone:904-272-5251
Mailing Address - Fax:904-276-0459
Practice Address - Street 1:1895 KINGSLEY AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4466
Practice Address - Country:US
Practice Address - Phone:904-272-5251
Practice Address - Fax:904-276-0459
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME86337207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1811041015OtherGROUP NPI
FLME86337OtherLICENSE NUMBER
FLME86337OtherLICENSE NUMBER