Provider Demographics
NPI:1073578001
Name:KWAN, PATRICK K (M D)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:K
Last Name:KWAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:KIN
Other - Middle Name:C
Other - Last Name:KWAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M D
Mailing Address - Street 1:801 N GRAND AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-3573
Mailing Address - Country:US
Mailing Address - Phone:940-665-0683
Mailing Address - Fax:940-668-2663
Practice Address - Street 1:801 N GRAND AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-3573
Practice Address - Country:US
Practice Address - Phone:940-665-0683
Practice Address - Fax:940-668-2663
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2415208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120593204Medicaid
TX120593202Medicaid
TX4357499OtherAETNA INSURANCE
TX120593202Medicaid
00625VMedicare ID - Type Unspecified
TX120593204Medicaid