Individual
PATRICK LIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 W DEAN KEETON, UHS, AUSTIN, TX 78712
(512) 485-8406
Mailing address
PO BOX 7339, UHS, AUSTIN, TX 78713-7339
(512) 485-8406
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101238459
VA
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
27489
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010207088
—
VA
01
—
10001036
SENTARA/OPTIMA
VA
01
—
186203
ANTHEM
VA
01
—
541595397
VIRGINIA HEALTH NETWORK
VA
01
—
7231606
AETNA
VA
Enumeration date
02/15/2006
Last updated
08/11/2010
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