Individual
PATRICK R MACIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3515 E FLETCHER AVE, BLDG 2, TAMPA, FL 33613-4702
(813) 974-2201
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME113376
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014283500
—
FL
01
—
14W24
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/12/2010
Last updated
03/31/2021
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