Provider Demographics
NPI:1033170303
Name:PATTY, BERNARD E (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:E
Last Name:PATTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 WINDERMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303
Mailing Address - Country:US
Mailing Address - Phone:318-487-2020
Mailing Address - Fax:318-445-7745
Practice Address - Street 1:231 WINDERMERE BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3538
Practice Address - Country:US
Practice Address - Phone:318-487-2020
Practice Address - Fax:318-445-7745
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011191207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1154369Medicaid
P00169986OtherTRAVELERS MEDICARE
B65317Medicare UPIN
54553Medicare ID - Type Unspecified