Provider Demographics
NPI:1467472076
Name:ROST, PATRICK MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MARTIN
Last Name:ROST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 W HONOR CT
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-2323
Mailing Address - Country:US
Mailing Address - Phone:623-551-6092
Mailing Address - Fax:
Practice Address - Street 1:ANTHEM VA CBOC
Practice Address - Street 2:3618 W. ANTHEM WAY; D-120
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086
Practice Address - Country:US
Practice Address - Phone:623-551-6092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD2352207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN