Provider Demographics
NPI:1063562635
Name:PATZAKIS, NICK J (DO)
Entity type:Individual
Prefix:DR
First Name:NICK
Middle Name:J
Last Name:PATZAKIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9725 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77016-4403
Mailing Address - Country:US
Mailing Address - Phone:713-633-7020
Mailing Address - Fax:713-633-5597
Practice Address - Street 1:9725 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77016-4403
Practice Address - Country:US
Practice Address - Phone:713-633-7020
Practice Address - Fax:713-633-5597
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC7410204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121543603Medicaid
TX121543603Medicaid
009496Medicare UPIN