Provider Demographics
NPI:1942285390
Name:PATSIAS, GEORGIS (MD)
Entity Type:Individual
Prefix:
First Name:GEORGIS
Middle Name:
Last Name:PATSIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3347 STATE ROAD 7
Practice Address - Street 2:SUITE 101
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8095
Practice Address - Country:US
Practice Address - Phone:561-790-2111
Practice Address - Fax:561-790-0348
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049282208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373720900Medicaid
FLP01596409OtherRR MEDICARE
FLP102736OtherOPTIMUN
FLP107179OtherFREEDOM
FL1249251OtherWELLCARE
FL18997OtherBCBS
FL3615094OtherKEYS PHA - CIGNA
FL1004500OtherCAREPLUS
FL4311OtherDIMENSIONS
FL5500033OtherAETNA
FL18997OtherBCBS
FL5500033OtherAETNA
FLP01596409OtherRR MEDICARE