Provider Demographics
NPI:1457643314
Name:PATTERSON, ADDIE (DO)
Entity Type:Individual
Prefix:
First Name:ADDIE
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 JEFFEY DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8441
Mailing Address - Country:US
Mailing Address - Phone:937-467-9119
Mailing Address - Fax:
Practice Address - Street 1:3450 HULL RD FL 4
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-4144
Practice Address - Country:US
Practice Address - Phone:352-294-5400
Practice Address - Fax:352-294-5426
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS132012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014995900Medicaid
FLIE716ZMedicare PIN