Provider Demographics
NPI:1659363018
Name:PATACXIL, FILEMON R (MD)
Entity Type:Individual
Prefix:DR
First Name:FILEMON
Middle Name:R
Last Name:PATACXIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FILEMON
Other - Middle Name:R
Other - Last Name:PATACSIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1706 RIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5318
Mailing Address - Country:US
Mailing Address - Phone:850-878-4823
Mailing Address - Fax:850-878-4893
Practice Address - Street 1:1706 RIGGINS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5318
Practice Address - Country:US
Practice Address - Phone:850-878-4823
Practice Address - Fax:850-878-4893
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066490OtherVISTA HEALTH PLAN
FL054950900Medicaid
FL080180490OtherMEDICARE RAILROAD CARRIER
FL066490OtherVISTA HEALTH PLAN
FL054950900Medicaid