Individual
DEBORAH O PATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
(812) 330-3688
(812) 331-3656
Mailing address
PO BOX 1329, BLOOMINGTON, IN 47402-1329
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01031491
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100055990
—
IN
Enumeration date
12/29/2005
Last updated
11/07/2018
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