Provider Demographics
NPI:1366421679
Name:MCCULLOCH, PATRICK C (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:C
Last Name:MCCULLOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-9000
Mailing Address - Fax:713-790-2141
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-9000
Practice Address - Fax:713-790-2141
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4338207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
616771101OtherUS DEPT OF LABOR
TX181848602Medicaid
616771110OtherUS DEPT OF LABOR
TX181848605Medicaid
601771109OtherUS DEPT OF LABOR
TXP00842117OtherMEDICARE RAILROAD
616771105OtherUS DEPT OF LABOR
TX181848603Medicaid
TX610197301 CENTERFIELOtherUS DEPT OF LABOR
TX0918730002OtherDME MEDICARE PROVIDER NUMBER
TX181848601Medicaid
TX610197302 FANNINOtherUS DEPT OF LABOR
TXP01102952OtherRR MEDICARE
TX1366421679OtherBLUE CROSS BLUE SHIELD
TX0918730002OtherDME MEDICARE PROVIDER NUMBER
616771101OtherUS DEPT OF LABOR
601771109OtherUS DEPT OF LABOR
TXI44500Medicare UPIN
TX306131YUD8Medicare PIN
TXTXB151155Medicare PIN
TX1366421679OtherBLUE CROSS BLUE SHIELD
TX181848602Medicaid
TX306131YMVQMedicare PIN
TX8G7590Medicare PIN
TX8L18952Medicare PIN