Provider Demographics
NPI:1578632584
Name:HEPBURN, PATRICK J SR (LMT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:HEPBURN
Suffix:SR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 34TH ST SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1782
Mailing Address - Country:US
Mailing Address - Phone:505-891-9796
Mailing Address - Fax:505-891-9796
Practice Address - Street 1:1808 34TH ST SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1782
Practice Address - Country:US
Practice Address - Phone:505-891-9796
Practice Address - Fax:505-891-9796
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLMT4662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist