Provider Demographics
NPI:1558399816
Name:CECCONI, PATRICIA PARKER (MD)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:PARKER
Last Name:CECCONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7909 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE #110
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3425
Mailing Address - Country:US
Mailing Address - Phone:210-614-4544
Mailing Address - Fax:210-679-3724
Practice Address - Street 1:414 NAVARRO ST
Practice Address - Street 2:SUITE # 900
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2516
Practice Address - Country:US
Practice Address - Phone:210-474-7020
Practice Address - Fax:210-679-3733
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM5088208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185574401Medicaid
TX8J3028Medicare PIN
TXI70849Medicare UPIN