Provider Demographics
NPI:1538513379
Name:PATTON, JASON MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
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 1:621 S ILLINOIS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:712-852-5555
Mailing Address - Fax:712-852-5560
Practice Address - Street 1:3201 1ST ST
Practice Address - Street 2:
Practice Address - City:EMMETSBURG
Practice Address - State:IA
Practice Address - Zip Code:50536-2516
Practice Address - Country:US
Practice Address - Phone:712-852-5555
Practice Address - Fax:712-852-5692
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-11019207P00000X
390200000X
IA46234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program