Provider Demographics
NPI:1033648647
Name:MIXA, PATRICK JAMES (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JAMES
Last Name:MIXA
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 1:1609 PASADENA AVE S STE 1A
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4514
Mailing Address - Country:US
Mailing Address - Phone:727-321-9644
Mailing Address - Fax:727-321-8580
Practice Address - Street 1:1609 PASADENA AVE S STE 1A
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4514
Practice Address - Country:US
Practice Address - Phone:727-321-9644
Practice Address - Fax:727-321-8580
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD94101207X00000X
FLME166702207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery