Provider Demographics
NPI:1639196645
Name:PATAKY, PAUL ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ERIC
Last Name:PATAKY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2623 S SEACREST BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7501
Mailing Address - Country:US
Mailing Address - Phone:561-734-5056
Mailing Address - Fax:561-734-0288
Practice Address - Street 1:2623 S SEACREST BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7501
Practice Address - Country:US
Practice Address - Phone:561-734-5056
Practice Address - Fax:561-734-0288
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL034720207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB76106Medicare UPIN
FL50914Medicare ID - Type Unspecified