Basic Information
| Provider Information | |||||||||
| NPI: | 1528011756 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BREDAR | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 62707 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339062707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399313440 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13813 METRO PKWY | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339124343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399313440 | ||||||||
| FaxNumber: | 2399368507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 12/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9100690 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 291703300 | 05 | FL | MEDICAID | Y0H8V | 01 | FL | FLORIDA BLUE | OTHER |