=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912944232
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL S PATRICK MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 12/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1303 E HERNDON AVE SUITE 200
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-3309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-450-3109
-----------------------------------------------------
Fax | 559-450-3674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6102
-----------------------------------------------------
City | NOVATO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94948-6102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-884-3404
-----------------------------------------------------
Fax | 415-883-1836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207UN0902X
-----------------------------------------------------
Taxonomy Name | Nuclear Imaging & Therapy Physician
-----------------------------------------------------
License Number | A92101
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------