Provider Demographics
NPI:1780645861
Name:O'DEA, PATRICK
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:O'DEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 BROWN TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3949
Mailing Address - Country:US
Mailing Address - Phone:817-281-8275
Mailing Address - Fax:
Practice Address - Street 1:4301 BROWN TRL
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-3949
Practice Address - Country:US
Practice Address - Phone:817-281-8275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81W605Medicare ID - Type Unspecified
TXB25227Medicare UPIN