Provider Demographics
NPI:1952446536
Name:PATRICK MANGONON MD PA
Entity Type:Organization
Organization Name:PATRICK MANGONON MD PA
Other - Org Name:DBA FLORIDA THORACIC AND CARDIOVASCULAR SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:MANGONON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-753-7890
Mailing Address - Street 1:PO BOX 210474
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33421-0474
Mailing Address - Country:US
Mailing Address - Phone:561-753-7890
Mailing Address - Fax:561-753-7775
Practice Address - Street 1:13005 SOUTHERN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9206
Practice Address - Country:US
Practice Address - Phone:561-753-7890
Practice Address - Fax:561-753-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77600208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1023067584OtherINDIVIDUAL NPI #
FL256707500Medicaid
FLP00736326OtherRAILROAD MEDICARE
FL256707500Medicaid
FLP00736326OtherRAILROAD MEDICARE