Provider Demographics
NPI:1659657666
Name:BRONSON, PATRICK ANTHONY (EMT-B)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:ANTHONY
Last Name:BRONSON
Suffix:
Gender:M
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 THORNE STREET
Mailing Address - Street 2:
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-2102
Mailing Address - Country:US
Mailing Address - Phone:901-484-7913
Mailing Address - Fax:
Practice Address - Street 1:BLD. 301 ANDREWS AVN.
Practice Address - Street 2:
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-4444
Practice Address - Country:US
Practice Address - Phone:334-255-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXB1922465146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic