Provider Demographics
NPI:1487688594
Name:CONWAY, PATRICK A (DO)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:A
Last Name:CONWAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 GRANBURY RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5912
Mailing Address - Country:US
Mailing Address - Phone:817-346-1925
Mailing Address - Fax:817-292-7237
Practice Address - Street 1:7001 GRANBURY RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-5912
Practice Address - Country:US
Practice Address - Phone:817-346-1925
Practice Address - Fax:817-292-7237
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166352805Medicaid
TX166352803Medicaid
TX8C9714Medicare PIN
TXH57984Medicare UPIN