Provider Demographics
NPI:1497933949
Name:PATRICK PROFFER, M.D.,P.A.
Entity Type:Organization
Organization Name:PATRICK PROFFER, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PROFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-352-1185
Mailing Address - Street 1:1611 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1763
Mailing Address - Country:US
Mailing Address - Phone:806-352-1185
Mailing Address - Fax:
Practice Address - Street 1:1611 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1763
Practice Address - Country:US
Practice Address - Phone:806-352-1185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0532208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174819602Medicaid