Individual
GENE R PATCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
10609 OLD SAINT AUGUSTINE RD STE 3, JACKSONVILLE, FL 32257-1019
(904) 268-1331
Mailing address
10609 OLD SAINT AUGUSTINE RD STE 3, JACKSONVILLE, FL 32257-1019
(904) 268-1331
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8952
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60820
BLUE CROSS-BLUE SHIELD
FL
01
—
637072
UNITED CONCORDIA INS
FL
Enumeration date
07/17/2006
Last updated
10/12/2015
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