Provider Demographics
NPI:1518125962
Name:PATHAN, ASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ASAD
Middle Name:
Last Name:PATHAN
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 1:4029 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-7006
Mailing Address - Country:US
Mailing Address - Phone:469-835-0914
Mailing Address - Fax:
Practice Address - Street 1:3180 EXECUTIVE DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904
Practice Address - Country:US
Practice Address - Phone:325-944-1240
Practice Address - Fax:325-944-8616
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-01
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4425207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty