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General NPI Number Information
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NPI Number | 1922210996
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Entity Type | Individual
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Provider Name | PAUL LYNDON PATRICK D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14805 TRINITY BLVD
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City | FORT WORTH
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State | TX
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Zip | 76155-2609
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Country | US
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Telephone | 817-318-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 QUAIL VALLEY LN UNIT 115
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City | ARLINGTON
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State | TX
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Zip | 76011-2892
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G9186
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License Number State | TX
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