Provider Demographics
NPI:1134127756
Name:PATTON, C MACK (MD)
Entity Type:Individual
Prefix:
First Name:C
Middle Name:MACK
Last Name:PATTON
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 1:822 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3718
Mailing Address - Country:US
Mailing Address - Phone:423-246-6251
Mailing Address - Fax:423-246-7230
Practice Address - Street 1:822 BROAD ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3718
Practice Address - Country:US
Practice Address - Phone:423-246-6251
Practice Address - Fax:423-246-7230
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD005768208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3173108Medicare ID - Type Unspecified
B03575Medicare UPIN