Provider Demographics
NPI:1790799864
Name:GINN, PATRICK DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DAVID
Last Name:GINN
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 1:1187 E HERNDON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3166
Mailing Address - Country:US
Mailing Address - Phone:559-440-0450
Mailing Address - Fax:559-440-0461
Practice Address - Street 1:1187 E HERNDON AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3166
Practice Address - Country:US
Practice Address - Phone:559-440-0450
Practice Address - Fax:559-440-0461
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50537207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100001423OtherMEDICARE RAILROAD
00G505370OtherBLUE CROSS
00G505370OtherBLUE SHIELD
CA00G505370Medicaid
00G505370OtherBLUE SHIELD
100001423OtherMEDICARE RAILROAD