Provider Demographics
NPI:1356384291
Name:PATRUSKY, ERIC G
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:G
Last Name:PATRUSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 BEE RIDGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1207
Mailing Address - Country:US
Mailing Address - Phone:941-377-8687
Mailing Address - Fax:941-378-3498
Practice Address - Street 1:3920 BEE RIDGE RD STE C
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1207
Practice Address - Country:US
Practice Address - Phone:941-377-8687
Practice Address - Fax:941-378-3498
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6274208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80732OtherBC/BS ID
FL632743OtherAETNA ID
FL80732OtherBC/BS ID