Healthcare Provider Details

I. General information

NPI: 1629039417
Provider Name (Legal Business Name): PATRICK B. PARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N HEWITT DR
HEWITT TX
76643-3038
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 254-420-5000
  • Fax:
Mailing address:
  • Phone: 254-724-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK5651
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: