Provider Demographics
NPI:1659471100
Name:KIMBRELL, PATRICK NEAL (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:NEAL
Last Name:KIMBRELL
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 1:2935 THOUSAND OAKS
Mailing Address - Street 2:SUITE 294
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3312
Mailing Address - Country:US
Mailing Address - Phone:210-494-1100
Mailing Address - Fax:210-494-1117
Practice Address - Street 1:5000 BAPTIST HEALTH DR STE 117
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1194
Practice Address - Country:US
Practice Address - Phone:210-626-8201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1292174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127423506Medicaid
TX00090037OtherMEDICARE RAILROAD
TX00090037OtherMEDICARE RAILROAD
G25684Medicare UPIN