Provider Demographics
NPI:1871592733
Name:PATRICK, MADISON WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:WILLIAM
Last Name:PATRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 270130
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-0130
Mailing Address - Country:US
Mailing Address - Phone:361-906-1617
Mailing Address - Fax:361-906-9923
Practice Address - Street 1:327 CORAL SEA RD
Practice Address - Street 2:SUITE 165
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362-5055
Practice Address - Country:US
Practice Address - Phone:361-776-1404
Practice Address - Fax:361-776-1103
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3806207P00000X, 208000000X
HIMD-4081207P00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics