Provider Demographics
NPI:1477616886
Name:PATTON, THERESA M (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:PATTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:M
Other - Last Name:PATTON-HARBIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1330 N BECKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1271
Mailing Address - Country:US
Mailing Address - Phone:214-697-2412
Mailing Address - Fax:
Practice Address - Street 1:1330 N BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1271
Practice Address - Country:US
Practice Address - Phone:214-941-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1162207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1574287-01Medicaid
TX0093JUOtherBLUE CROSS-BLUE SHIELD
TX7350471OtherAETNA
TXP00019789OtherRAILROAD MEDICARE
TX0093JUOtherBLUE CROSS-BLUE SHIELD
TX00394VMedicare ID - Type UnspecifiedMEDICARE GROUP #
TX8A8271Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #