Provider Demographics
NPI:1063480853
Name:DALY, PATRICK W (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:W
Last Name:DALY
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 1:3629 FAIRMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4710
Mailing Address - Country:US
Mailing Address - Phone:214-526-3566
Mailing Address - Fax:
Practice Address - Street 1:3629 FAIRMOUNT ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4710
Practice Address - Country:US
Practice Address - Phone:214-526-3566
Practice Address - Fax:214-522-8619
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752317753OtherTAXID
TX0354961-01Medicaid
TXC14992Medicare UPIN
TX0354961-01Medicaid