Provider Demographics
NPI:1629165329
Name:JUSTIZ, PATRICK J (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:JUSTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12876 PACKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:N PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-2246
Mailing Address - Country:US
Mailing Address - Phone:561-385-3133
Mailing Address - Fax:
Practice Address - Street 1:5051 SE 110TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3115
Practice Address - Country:US
Practice Address - Phone:352-674-1730
Practice Address - Fax:352-674-8930
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63347207Q00000X
FLME80578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA63347OtherBLUE CROSS
CA115OtherCMSP
CA00G601660OtherBLUE SHIELD OF CALIFORNIA
CA115OtherCMSP
WA63347GMedicare PIN
CAP00004626Medicare PIN
FL51709YMedicare PIN
CA00G601660OtherBLUE SHIELD OF CALIFORNIA
WA63347DMedicare PIN