Provider Demographics
NPI:1144228578
Name:HISEL, PATRICK WARREN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:WARREN
Last Name:HISEL
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:PO BOX 2333
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-7333
Mailing Address - Country:US
Mailing Address - Phone:940-325-6831
Mailing Address - Fax:940-325-6891
Practice Address - Street 1:750 EUREKA ST STE B
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6521
Practice Address - Country:US
Practice Address - Phone:940-325-6831
Practice Address - Fax:940-325-6891
Is Sole Proprietor?:No
Enumeration Date:2005-07-10
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148044408Medicaid
TXH50418Medicare UPIN
8F1368Medicare PIN