Healthcare Provider Details

I. General information

NPI: 1467613471
Provider Name (Legal Business Name): LANCE PATAK M.D., MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9835 N LAKE CREEK PKWY
AUSTIN TX
78717-6210
US

IV. Provider business mailing address

9835 N LAKE CREEK PKWY
AUSTIN TX
78717-6210
US

V. Phone/Fax

Practice location:
  • Phone: 737-229-1912
  • Fax:
Mailing address:
  • Phone: 737-229-1912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberU4300
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberU4300
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: