1578545109 NPI number — DR. ROBERT GREG PATTERSON M.D.

Table of content: DR. ROBERT GREG PATTERSON M.D. (NPI 1578545109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578545109 NPI number — DR. ROBERT GREG PATTERSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTERSON
Provider First Name:
ROBERT
Provider Middle Name:
GREG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1578545109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2645 HOUGHTON HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH POLE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99705-6572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-488-9085
Provider Business Mailing Address Fax Number:
907-377-0140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2630 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 1M07
Provider Business Practice Location Address City Name:
EIELSON AFB
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99702-2325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-377-1847
Provider Business Practice Location Address Fax Number:
907-377-0140
Provider Enumeration Date:
11/18/2005

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: 207Q00000X , with the licence number:  01048153A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 9685171-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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