Provider Demographics
NPI:1275536948
Name:PATTON, GREGORY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALAN
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 1:265 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1800
Mailing Address - Country:US
Mailing Address - Phone:503-528-5013
Mailing Address - Fax:503-528-5255
Practice Address - Street 1:265 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1800
Practice Address - Country:US
Practice Address - Phone:503-528-5013
Practice Address - Fax:503-528-5255
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD231542085R0203X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1006524Medicaid
OR168689Medicaid
WA1006524Medicaid
OR110278Medicare PIN
WAG8882687Medicare PIN