Basic Information
| Provider Information | |||||||||
| NPI: | 1912023169 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEK | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | COLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 RAYNOLDS ST # 51015 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799051613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152154480 | ||||||||
| FaxNumber: | 9152155386 | ||||||||
| Practice Location | |||||||||
| Address1: | 4815 ALAMEDA AVE | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799052705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152154600 | ||||||||
| FaxNumber: | 9155457338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1663-697T | LA | N | Eye and Vision Services Providers | Optometrist | 207P00000X | GETP.200934 | LA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | Q8119 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.