Provider Demographics
NPI:1629096540
Name:GEORGIS PATSIAS MD PA
Entity Type:Organization
Organization Name:GEORGIS PATSIAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATISIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-753-3787
Mailing Address - Street 1:1397 MEDICAL PARK BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6108
Mailing Address - Country:US
Mailing Address - Phone:561-753-3787
Mailing Address - Fax:561-753-3793
Practice Address - Street 1:1397 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6108
Practice Address - Country:US
Practice Address - Phone:561-753-3787
Practice Address - Fax:561-753-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049282208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18997Medicare ID - Type UnspecifiedMEDICARE
FLF64107Medicare UPIN