Provider Demographics
NPI:1013914092
Name:PATRICE, STEPHEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:PATRICE
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:
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 1:3210 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6411
Practice Address - Country:US
Practice Address - Phone:941-364-8887
Practice Address - Fax:941-954-3222
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00707182085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6850OtherAVMED PIN NUMBER
FL207227OtherAMERIGROUP GROUP NUMBER
FL24-06256OtherUTD. HLTHCR. PROVIDER #
FL5594330OtherAETNA PROVIDER NUMBER
FL3082505-022OtherCIGNA PROVIDER NUMBER
FL144023-01OtherCITRUS HLTHCR. PROVIDER #
FL71354OtherOP. ENG. LOC. 825 PROV. #
FL25667OtherWELLCARE ID #
FL203910OtherAVMED PROVIDER NUMBER
FLME70718AOtherMETCARE PROVIDER ID #
FLP-11202016OtherMULTIPLAN PROVIDER NUMBER
FL3082505-022OtherCIGNA PROVIDER NUMBER
FL5594330OtherAETNA PROVIDER NUMBER