Provider Demographics
NPI:1114967163
Name:PATTEN, CRAIG P (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:P
Last Name:PATTEN
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 10
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-0010
Mailing Address - Country:US
Mailing Address - Phone:866-898-7136
Mailing Address - Fax:616-975-9827
Practice Address - Street 1:1034 NORTH 500 WEST
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-373-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2785521205207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
930085777OtherRAILROAD MEDICARE
P00395947OtherRR MEDICARE
UT107005683103OtherSELECT HEALTH
UTD3067Medicaid
UT94278552104001OtherBCBS
UT94278552105001OtherBCBS
UT94278552100001OtherBCBS
UT870492357PA1OtherEDUCATORS MUTUAL
UT870636000PATOtherEDUCATORS MUTUAL
UT94278552105001OtherBCBS
930085777OtherRAILROAD MEDICARE
005787603Medicare PIN
006294027Medicare PIN
P00395947OtherRR MEDICARE
UTD3067Medicaid