Basic Information
| Provider Information | |||||||||
| NPI: | 1275706830 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADDO | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | GYAMFI | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1380 RIVER BEND DR | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752474914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147436159 | ||||||||
| FaxNumber: | 2146896482 | ||||||||
| Practice Location | |||||||||
| Address1: | 1350 N WESTMORELAND RD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752111654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146895140 | ||||||||
| FaxNumber: | 2146303625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2008 | ||||||||
| LastUpdateDate: | 07/19/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA06202 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA19649 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | MA053771 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 4362 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.