Provider Demographics
NPI:1255314084
Name:PATTERSON, JERRY WELDON (DPM)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:WELDON
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DPM
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:423 TREELINE PARK
Mailing Address - Street 2:SUITE 315
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2079
Mailing Address - Country:US
Mailing Address - Phone:210-614-9610
Mailing Address - Fax:210-614-9613
Practice Address - Street 1:423 TREELINE PARK
Practice Address - Street 2:STE 315
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2079
Practice Address - Country:US
Practice Address - Phone:210-614-9610
Practice Address - Fax:210-614-9613
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXTX0457213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB157574Medicare UPIN