MEDICARE: DR. PATRICK JONATHAN PROFFER 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	2086S0122X	Plastic and Reconstructive Surgery Physician	M0532	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00418009	OTHER	TX	PALMETTO GBS/RAILROAD MEDICARE

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

General Provider Information

NPI Number	:	1952399206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK JONATHAN PROFFER M.D.

Provider Business Mailing Address
First Line	:	1611 WALLACE BLVD
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-1799
Country	:	US
Telephone Number	:	806-352-1185
Fax Number	:	806-352-4987

Provider Business Practice Location Address
First Line	:	1611 WALLACE BLVD
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-1799
Country	:	US
Telephone Number	:	806-352-1185
Fax Number	:	806-352-4987

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	02/20/2014

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Directions to “ DR. PATRICK JONATHAN PROFFER M.D.” Practice Location

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