Provider Demographics
NPI:1598831281
Name:VINYARD, PATRICK G (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:G
Last Name:VINYARD
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 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:844-630-0700
Mailing Address - Fax:
Practice Address - Street 1:4360 GRECO DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222
Practice Address - Country:US
Practice Address - Phone:210-648-8200
Practice Address - Fax:855-392-7988
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7267208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047262302Medicaid
TX047262302Medicaid
TX8J0923Medicare PIN
TX00931XMedicare PIN