Provider Demographics
NPI:1437109097
Name:PATTON, ROBERT CLYDE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CLYDE
Last Name:PATTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:C
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:59 E PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-3440
Mailing Address - Country:US
Mailing Address - Phone:479-445-8779
Mailing Address - Fax:
Practice Address - Street 1:59 E PROSPECT ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-3440
Practice Address - Country:US
Practice Address - Phone:479-445-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-4745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR81752NOtherMEDICARE PROVIDER NUMBER
TX136749224Medicaid
AR136749201Medicaid
TX8F0106TXOtherMEDICARE - TEXAS
AR81752NOtherMEDICARE PROVIDER NUMBER
TX136749224Medicaid