Provider Demographics
NPI:1134111941
Name:PATTERSON, GWYNN RAWDING (MD)
Entity Type:Individual
Prefix:DR
First Name:GWYNN
Middle Name:RAWDING
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 E MEDITERRANEAN DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2494
Mailing Address - Country:US
Mailing Address - Phone:520-417-2229
Mailing Address - Fax:520-417-2266
Practice Address - Street 1:4990 E MEDITERRANEAN DR
Practice Address - Street 2:SUITE C
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2494
Practice Address - Country:US
Practice Address - Phone:520-417-2229
Practice Address - Fax:520-417-2266
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2014-09-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
AZ14904170100000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ270348002Medicaid
AZ2700348002Medicaid
AZ270348002Medicaid
AZD37424Medicare UPIN