Provider Demographics
NPI:1275529414
Name:PATTISON, JOSEPH R (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:PATTISON
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 1:2561 OAK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4559
Mailing Address - Country:US
Mailing Address - Phone:904-389-6009
Mailing Address - Fax:904-384-5354
Practice Address - Street 1:2561 OAK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4559
Practice Address - Country:US
Practice Address - Phone:904-384-6009
Practice Address - Fax:904-384-5354
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15986Medicare ID - Type Unspecified
FLD52809Medicare UPIN