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General NPI Number Information
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NPI Number | 1770888315
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Entity Type | Organization
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Legal Business Name | PATRICK DONOVAN MD PA
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 6701 OAKMONT BLVD
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City | FORT WORTH
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State | TX
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Zip | 76132-2957
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Country | US
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Telephone | 817-332-7650
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Fax | 817-332-3755
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Provider Business Mailing Address
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Address Line | 6701 OAKMONT BLVD
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City | FORT WORTH
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State | TX
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Zip | 76132-2957
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Country | US
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Telephone | 817-332-7650
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Fax | 817-332-3755
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK DONOVAN
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Credential | MD
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Telephone | 817-332-7650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | H6169
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License Number State | TX
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