Provider Demographics
NPI:1730157041
Name:RADER, PATRICK N (DO)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:N
Last Name:RADER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8614 BAYMEADOWS WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8236
Mailing Address - Country:US
Mailing Address - Phone:904-376-3707
Mailing Address - Fax:904-346-0212
Practice Address - Street 1:8614 BAYMEADOWS WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8236
Practice Address - Country:US
Practice Address - Phone:904-396-0450
Practice Address - Fax:904-346-0212
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01301105OtherRAILROAD MEDICARE
FL266916100Medicaid
FL266916100Medicaid
FLU0677XMedicare PIN