Provider Demographics
NPI:1235143041
Name:PATTERSON, GEORGE GORDON (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:GORDON
Last Name:PATTERSON
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 1496
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602
Mailing Address - Country:US
Mailing Address - Phone:870-741-2500
Mailing Address - Fax:870-741-7618
Practice Address - Street 1:724 N SPRING ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601
Practice Address - Country:US
Practice Address - Phone:870-741-2500
Practice Address - Fax:870-741-7618
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR53704OtherBC
AR01915193OtherDEPT OF LABOR
AR117485001Medicaid
D93352Medicare UPIN
AR117485001Medicaid