Provider Demographics
NPI:1235166877
Name:PATTERSON, LES (MSC)
Entity Type:Individual
Prefix:DR
First Name:LES
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:954-747-6111
Mailing Address - Fax:954-747-3399
Practice Address - Street 1:7540 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2132
Practice Address - Country:US
Practice Address - Phone:954-747-6111
Practice Address - Fax:954-747-3399
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1445231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600556000Medicaid
FL600556000Medicaid