Provider Demographics
NPI:1356314520
Name:PATTERSON, THOMAS R (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:PATTERSON
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 1:677 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3600
Mailing Address - Country:US
Mailing Address - Phone:541-461-7550
Mailing Address - Fax:541-461-7697
Practice Address - Street 1:677 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3600
Practice Address - Country:US
Practice Address - Phone:541-461-7550
Practice Address - Fax:541-461-7697
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD163934207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA103110OtherCIGNA
VA5618339OtherVA PREMIER
VA142935OtherSOUTHERN HEALTH
VA270486OtherANTHEM
VA2200838OtherFIRST HEALTH
VA005618339Medicaid
VA41422OtherOPTIMA
VA080139800Medicare PIN
VAC81768Medicare UPIN
VAC05923Medicare PIN
VA41422OtherOPTIMA
VA080005413Medicare ID - Type Unspecified