Provider Demographics
NPI:1235178963
Name:PATTON, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
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 1:9146 HIGHWAY 63 N
Mailing Address - Street 2:C/O HOUSE MEDICAL CLINIC
Mailing Address - City:BONO
Mailing Address - State:AR
Mailing Address - Zip Code:72416-8153
Mailing Address - Country:US
Mailing Address - Phone:870-930-9990
Mailing Address - Fax:870-930-9992
Practice Address - Street 1:9146 HIGHWAY 63 N
Practice Address - Street 2:
Practice Address - City:BONO
Practice Address - State:AR
Practice Address - Zip Code:72416-8153
Practice Address - Country:US
Practice Address - Phone:870-930-9990
Practice Address - Fax:870-930-9992
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149911001Medicaid
AR5M097Medicare ID - Type Unspecified
AR149911001Medicaid
MO209273408Medicare ID - Type Unspecified