Provider Demographics
NPI:1467442467
Name:PATTERSON, THOMAS S (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:S
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 1:777 N RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9251
Mailing Address - Country:US
Mailing Address - Phone:208-514-2500
Mailing Address - Fax:208-375-2217
Practice Address - Street 1:777 N RAYMOND ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9251
Practice Address - Country:US
Practice Address - Phone:208-514-2500
Practice Address - Fax:208-375-2217
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7458208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805185100Medicaid
ID000010034815OtherBLUE SHIELD
ID45187OtherBLUE CROSS
ID370014214OtherRAILROAD MEDICARE
ID806353600OtherHEALTHY CONNECTIONS
ID000010004870OtherBLUE SHIELD
IDDM743OtherBLUE CROSS
ID1467442467Medicaid
ID370014214OtherRAILROAD MEDICARE
ID45187OtherBLUE CROSS
ID1467442467Medicaid
ID805185100Medicaid
ID20009278Medicare PIN
IDDM743OtherBLUE CROSS