Provider Demographics
NPI:1861218141
Name:PATINO, CARLOS SAUL (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:SAUL
Last Name:PATINO
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 1:4258 N HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-6129
Mailing Address - Country:US
Mailing Address - Phone:404-388-1340
Mailing Address - Fax:
Practice Address - Street 1:4258 N HONEYSUCKLE LN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-6129
Practice Address - Country:US
Practice Address - Phone:404-388-1340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05308207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology