Provider Demographics
NPI:1942271135
Name:DONOVAN, PATRICK WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WILLIAM
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6701 OAKMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2957
Mailing Address - Country:US
Mailing Address - Phone:817-332-7650
Mailing Address - Fax:817-332-3755
Practice Address - Street 1:6701 OAKMONT BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-2957
Practice Address - Country:US
Practice Address - Phone:817-332-7650
Practice Address - Fax:817-332-3755
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH6169208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089765401Medicaid
TX089765401Medicaid
TX00J92JMedicare PIN