Provider Demographics
NPI:1699876201
Name:ARLEDGE, PATRICIA R (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:ARLEDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 9TH ST.
Mailing Address - Street 2:SUITE 270
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415
Mailing Address - Country:US
Mailing Address - Phone:806-788-5598
Mailing Address - Fax:806-788-0598
Practice Address - Street 1:3502 9TH ST.
Practice Address - Street 2:SUITE 270
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415
Practice Address - Country:US
Practice Address - Phone:806-788-5598
Practice Address - Fax:806-788-0598
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9992208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB6365OtherMEDICAID
106097202OtherCIDC
107672101OtherFIRSTCARE MEDICAID
8A1972OtherBLUE CROSS BLUE SHIELD
TX106097201Medicaid
107672100OtherFIRSTCARE/SWLH
G80085Medicare UPIN
8923K1Medicare ID - Type Unspecified