Provider Demographics
NPI:1174542815
Name:PATRICK, STEPHEN K (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:K
Last Name:PATRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 N. BECKLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203
Mailing Address - Country:US
Mailing Address - Phone:214-947-2300
Mailing Address - Fax:214-947-5948
Practice Address - Street 1:122 W. COLORADO BLVD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208
Practice Address - Country:US
Practice Address - Phone:214-947-6700
Practice Address - Fax:214-947-6701
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6503207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A4434OtherBCBS
TX106076603Medicaid
TX160054411OtherRAILROAD MEDICARE
TX106076604Medicaid
TX160054411OtherRAILROAD MEDICARE
TX106076604Medicaid
TXF31526Medicare UPIN