Provider Demographics
NPI:1770963282
Name:DICOSIMO, PATRICK VINCENT (MD, MS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:VINCENT
Last Name:DICOSIMO
Suffix:
Gender:M
Credentials:MD, MS
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Mailing Address - Street 1:7701 WURZBACH RD APT 402
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4429
Mailing Address - Country:US
Mailing Address - Phone:832-465-8003
Mailing Address - Fax:
Practice Address - Street 1:1310 MCCULLOUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212
Practice Address - Country:US
Practice Address - Phone:210-757-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXR7200207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine