Provider Demographics
NPI:1588638159
Name:MCPOLAND, PATRIC R (MD)
Entity Type:Individual
Prefix:
First Name:PATRIC
Middle Name:R
Last Name:MCPOLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4475 MEDICAL CENTER WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3240
Mailing Address - Country:US
Mailing Address - Phone:561-863-1000
Mailing Address - Fax:561-863-1319
Practice Address - Street 1:4475 MEDICAL CENTER WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3240
Practice Address - Country:US
Practice Address - Phone:561-863-1000
Practice Address - Fax:561-863-1319
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME49528207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E65220Medicare UPIN
FL09100ZMedicare ID - Type Unspecified