1003974486 NPI number — DR. JOHN WILLIAM PATTON III MD

Table of content: DR. JOHN WILLIAM PATTON III MD (NPI 1003974486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003974486 NPI number — DR. JOHN WILLIAM PATTON III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTON
Provider First Name:
JOHN
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003974486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 510
Provider Second Line Business Mailing Address:
39780 ROAD G
Provider Business Mailing Address City Name:
MANCOS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-533-1970
Provider Business Mailing Address Fax Number:
970-533-1261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1311 N MILDRED ST NE
Provider Second Line Business Practice Location Address:
SW MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
CORTEZ
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
950-565-6666
Provider Business Practice Location Address Fax Number:
970-564-2049
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  38470 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 84239361 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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