Provider Demographics
NPI:1629106968
Name:EDGAR PATINO, M.D., P.A.
Entity Type:Organization
Organization Name:EDGAR PATINO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-669-7363
Mailing Address - Street 1:7600 S RED RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5428
Mailing Address - Country:US
Mailing Address - Phone:305-669-7363
Mailing Address - Fax:305-663-1118
Practice Address - Street 1:7600 S RED RD
Practice Address - Street 2:SUITE 225
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5428
Practice Address - Country:US
Practice Address - Phone:305-669-7363
Practice Address - Fax:305-663-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 413222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL36365OtherBLUE CROSS BLUE SHIELD
FL36365OtherBLUE CROSS BLUE SHIELD