Provider Demographics
NPI:1528149416
Name:PATRICK W HISEL, MD, PA
Entity type:Organization
Organization Name:PATRICK W HISEL, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:HISEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-325-6831
Mailing Address - Street 1:PO BOX 2333
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-7333
Mailing Address - Country:US
Mailing Address - Phone:940-325-6831
Mailing Address - Fax:940-325-6891
Practice Address - Street 1:750 EUREKA ST STE B
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6521
Practice Address - Country:US
Practice Address - Phone:940-325-6831
Practice Address - Fax:940-325-6891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148044407Medicaid
TXH50418Medicare UPIN
TX148044407Medicaid