Healthcare Provider Details

I. General information

NPI: 1962466748
Provider Name (Legal Business Name): DONALD L PATRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 RODGERS DR
SEARCY AR
72143-7432
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 501-203-0857
  • Fax: 501-203-0864
Mailing address:
  • Phone: 870-347-3524
  • Fax: 870-347-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberR2139
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberK8415
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberR-2139
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: