Provider Demographics
NPI:1063486413
Name:PATTERSON, JOSEPH MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:PATTERSON
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 1:2201 HORIZAN RD
Mailing Address - Street 2:STE 4
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-2926
Mailing Address - Country:US
Mailing Address - Phone:870-732-1224
Mailing Address - Fax:870-732-1533
Practice Address - Street 1:318 S RHODES ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4215
Practice Address - Country:US
Practice Address - Phone:870-732-1224
Practice Address - Fax:870-732-1533
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0764174400000X, 207P00000X
ARE-0764208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K061OtherBC/BS
AR129277001Medicaid
F11834Medicare UPIN
AR5K061Medicare PIN