Provider Demographics
NPI:1821735168
Name:FAGAN, PATRICK M II (FNP)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:M
Last Name:FAGAN
Suffix:II
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11510 DERBYSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3102
Mailing Address - Country:US
Mailing Address - Phone:956-222-1999
Mailing Address - Fax:
Practice Address - Street 1:566 VETERANS DRIVE
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061
Practice Address - Country:US
Practice Address - Phone:210-231-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine