Provider Demographics
NPI:1235100876
Name:PATTERSON, JOHN A (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:740 S LIMESTONE
Mailing Address - Street 2:K302 KENTUCKY CLINIC
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-323-6711
Mailing Address - Fax:859-323-6661
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:K302 KENTUCKY CLINIC
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-6711
Practice Address - Fax:859-323-6661
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY18031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64108318Medicaid
183875Medicare PIN
KYC74074Medicare UPIN
KYC74074Medicare ID - Type UnspecifiedRIVERBEND GOVERNMENT
KY6606Medicare ID - Type Unspecified
DC6316Medicare PIN