Provider Demographics
NPI:1174799514
Name:PATOIR, TERRY
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:PATOIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 SKYRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5287
Mailing Address - Country:US
Mailing Address - Phone:352-242-3810
Mailing Address - Fax:352-242-3810
Practice Address - Street 1:645 SKYRIDGE RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5287
Practice Address - Country:US
Practice Address - Phone:352-242-3810
Practice Address - Fax:352-242-3810
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL230563100Medicaid