Provider Demographics
NPI:1629030804
Name:GLEASON, PATRICK LANGHAM (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LANGHAM
Last Name:GLEASON
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 1:1227 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2313
Mailing Address - Country:US
Mailing Address - Phone:361-883-4323
Mailing Address - Fax:361-883-8216
Practice Address - Street 1:1227 3RD ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2313
Practice Address - Country:US
Practice Address - Phone:361-883-4323
Practice Address - Fax:361-883-8216
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6913207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1606519-01Medicaid
TXP00050694OtherMEDICARE RR
TX8A6866Medicare ID - Type UnspecifiedMEDICARE
TXG12007Medicare UPIN
TXP00050694OtherMEDICARE RR