Provider Demographics
NPI:1083912323
Name:PATTERSON, DALLAS JUSTIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:JUSTIN
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:423 TREELINE PARK
Mailing Address - Street 2:SUITE #315
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2060
Mailing Address - Country:US
Mailing Address - Phone:210-614-9610
Mailing Address - Fax:210-614-9613
Practice Address - Street 1:423 TREELINE PARK
Practice Address - Street 2:SUITE #315
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2060
Practice Address - Country:US
Practice Address - Phone:210-614-9610
Practice Address - Fax:210-614-9613
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1998213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-5081812OtherEIN
TX45-5081812OtherEIN