Provider Demographics
NPI:1083615124
Name:LETT, PATRICK W (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:W
Last Name:LETT
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:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-0729
Mailing Address - Country:US
Mailing Address - Phone:334-793-2663
Mailing Address - Fax:334-836-2248
Practice Address - Street 1:404 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2563
Practice Address - Country:US
Practice Address - Phone:334-308-9797
Practice Address - Fax:334-308-2909
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25206207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-21927OtherBCBS OF AL 404 N MAIN ST
GA003129579AMedicaid
AL009957045Medicaid
AL511-30528OtherBCBS OF AL - HEALTHWEST
GA003129579AMedicaid
AL009957045Medicaid