MEDICARE: DR. PATRICK K KWAN M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	G2415	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4357499	OTHER	TX	AETNA INSURANCE

General Provider Information

NPI Number	:	1073578001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK K KWAN M. D.

Provider Business Mailing Address
First Line	:	801 N GRAND AVE
Second Line	:	SUITE 4
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-3573
Country	:	US
Telephone Number	:	940-665-0683
Fax Number	:	940-668-2663

Provider Business Practice Location Address
First Line	:	801 N GRAND AVE
Second Line	:	SUITE 4
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-3573
Country	:	US
Telephone Number	:	940-665-0683
Fax Number	:	940-668-2663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	03/10/2010

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