Provider Demographics
NPI:1417947839
Name:PATTERSON, CHRISTOPHER DALE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DALE
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12294 INDIAN ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3001
Mailing Address - Country:US
Mailing Address - Phone:727-595-2534
Mailing Address - Fax:727-595-5059
Practice Address - Street 1:12294 INDIAN ROCKS RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3001
Practice Address - Country:US
Practice Address - Phone:727-595-2534
Practice Address - Fax:727-595-5059
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS006914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG31584Medicare UPIN
FL57258ZMedicare ID - Type UnspecifiedMEDICARE
FLK2192Medicare PIN