Provider Demographics
NPI:1801948179
Name:HERNAN PATINO, MD, PA
Entity type:Organization
Organization Name:HERNAN PATINO, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-725-1200
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:TX
Mailing Address - Zip Code:78962-0156
Mailing Address - Country:US
Mailing Address - Phone:979-725-1200
Mailing Address - Fax:979-725-1240
Practice Address - Street 1:503A S EAGLE ST
Practice Address - Street 2:
Practice Address - City:WEIMAR
Practice Address - State:TX
Practice Address - Zip Code:78962
Practice Address - Country:US
Practice Address - Phone:979-725-1200
Practice Address - Fax:979-725-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D1261Medicare ID - Type Unspecified
TXC20287Medicare UPIN