Provider Demographics
NPI:1225323348
Name:PATTERSON, ALICIA (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3131 LA CANADA ST STE 217
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2579
Mailing Address - Country:US
Mailing Address - Phone:702-367-1525
Mailing Address - Fax:702-369-7153
Practice Address - Street 1:3131 LA CANADA ST STE 217
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2579
Practice Address - Country:US
Practice Address - Phone:702-367-1525
Practice Address - Fax:702-369-7153
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01077847A208600000X, 2086S0127X
SC33819208600000X
IAMD-46283208600000X, 2086S0102X
NV22241208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300017420Medicaid