Provider Demographics
NPI:1447231196
Name:PATTON, DENNIS R (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:R
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:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-838-5702
Mailing Address - Fax:314-839-5596
Practice Address - Street 1:1225 GRAHAM RD
Practice Address - Street 2:SUITE C-1330
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8012
Practice Address - Country:US
Practice Address - Phone:314-838-5702
Practice Address - Fax:314-839-5596
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5088146OtherAETNA
MO000000010028OtherESSENCE
MO265223OtherHEALTHLINK
MOG33244OtherMERCY
MO106639OtherBCBS
MO0400909OtherUHC
0400813OtherUHC MEDICARE COMPLETE
MO127473OtherGHP
MO019012451Medicare PIN
MO106639OtherBCBS
MO0400909OtherUHC
MO110137546Medicare PIN