Provider Demographics
NPI:1780751867
Name:FALLON, PATRICK EDWARD (DO)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:EDWARD
Last Name:FALLON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 GUADALUPE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-4223
Mailing Address - Country:US
Mailing Address - Phone:512-419-2783
Mailing Address - Fax:512-419-2781
Practice Address - Street 1:4110 GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4223
Practice Address - Country:US
Practice Address - Phone:512-419-2783
Practice Address - Fax:512-419-2781
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK50992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0092NGOtherBCBS
TX0455032-04Medicaid
TX8K6905Medicare PIN
8K6905Medicare PIN
0092NGOtherBCBS