1285723114 NPI number — DR. ROBERT PATTERSON M.D.

Table of content: DR. ROBERT PATTERSON M.D. (NPI 1285723114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285723114 NPI number — DR. ROBERT PATTERSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTERSON
Provider First Name:
ROBERT
Provider Middle Name:
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:
1285723114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84127-0128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-855-2941
Provider Business Mailing Address Fax Number:
801-765-5091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1159 E 200 N
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
AMERICAN FORK
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84003-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-855-2941
Provider Business Practice Location Address Fax Number:
801-756-5091
Provider Enumeration Date:
10/11/2006

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: 208600000X , with the licence number:  MD12557 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 553348 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000247254 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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