Individual
DR. PATRICK JONATHAN PROFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1611 WALLACE BLVD, AMARILLO, TX 79106-1799
(806) 352-1185
(806) 352-4987
Mailing address
1611 WALLACE BLVD, AMARILLO, TX 79106-1799
(806) 352-1185
(806) 352-4987
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
M0532
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
174819602
—
TX
01
—
P00418009
PALMETTO GBS/RAILROAD MEDICARE
TX
Enumeration date
10/11/2005
Last updated
02/20/2014
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