Provider Demographics
NPI:1699897538
Name:GATMAITAN, PATRICK TENGCO (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:TENGCO
Last Name:GATMAITAN
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 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-539-4091
Practice Address - Street 1:1890 SUMMIT BLVD STE 120
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-3357
Practice Address - Country:US
Practice Address - Phone:850-416-2959
Practice Address - Fax:850-416-4865
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116185208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023302310001Medicaid
PA155345Medicare PIN
PA1023302310001Medicaid