Provider Demographics
NPI:1306933007
Name:ANDRES, PATRICIO MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIO
Middle Name:MANUEL
Last Name:ANDRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:U.S. ARMY OCCUPATIONAL HEALTH CLINIC
Mailing Address - Street 2:RED RIVER ARMY DEPOT
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75507-5000
Mailing Address - Country:US
Mailing Address - Phone:903-334-2155
Mailing Address - Fax:
Practice Address - Street 1:4501 SUMMERHILL RD
Practice Address - Street 2:APT. # 231
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4422
Practice Address - Country:US
Practice Address - Phone:903-334-2155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD0034967171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider