Provider Demographics
NPI:1568436913
Name:PATTON, WALTER STINNETT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:STINNETT
Last Name:PATTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5550 E HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2919
Mailing Address - Country:US
Mailing Address - Phone:520-721-8605
Mailing Address - Fax:520-721-4209
Practice Address - Street 1:5550 E HAMPTON ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2919
Practice Address - Country:US
Practice Address - Phone:520-721-8605
Practice Address - Fax:520-721-4209
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12157207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ215477Medicaid
D37427Medicare UPIN
16WCKDN01Medicare ID - Type Unspecified