1710957295 NPI number — DR. NEIL A PATTERSON MD

Table of content: DR. NEIL A PATTERSON MD (NPI 1710957295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710957295 NPI number — DR. NEIL A PATTERSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTERSON
Provider First Name:
NEIL
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
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:
1710957295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2984 ALAFAYA TRL
Provider Second Line Business Mailing Address:
SUITE 2020
Provider Business Mailing Address City Name:
OVIEDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32765-7628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-366-2020
Provider Business Mailing Address Fax Number:
407-366-2559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2984 ALAFAYA TRL
Provider Second Line Business Practice Location Address:
SUITE 2020
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765-7628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-366-2020
Provider Business Practice Location Address Fax Number:
407-366-2559
Provider Enumeration Date:
01/25/2006

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: 207Q00000X , with the licence number:  ME 57057 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14697 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2089596 . This is a "AETNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 377304300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0622635 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4312636 . This is a "AETNA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2089583 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 59-3260952 . This is a "OTHER CARRIERS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2285311-017 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 748820 . This is a "FIRST HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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