MEDICARE: PAUL LYNDON PATRICK D.O.

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	G9186	TX

General Provider Information

NPI Number	:	1922210996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL LYNDON PATRICK D.O.

Provider Business Mailing Address
First Line	:	1105 QUAIL VALLEY LN UNIT 115
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-2892
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14805 TRINITY BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76155-2609
Country	:	US
Telephone Number	:	817-318-1700
Fax Number	:

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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