Provider Demographics
NPI:1578620266
Name:PATTERSON, RUSHTON E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSHTON
Middle Name:E
Last Name:PATTERSON
Suffix:JR
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 1:4325 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-5739
Mailing Address - Country:US
Mailing Address - Phone:901-386-1818
Mailing Address - Fax:901-386-7499
Practice Address - Street 1:4325 STAGE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5739
Practice Address - Country:US
Practice Address - Phone:901-386-1818
Practice Address - Fax:901-386-7499
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD016157207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3019555Medicaid
TNA98330Medicare UPIN
TN3019555Medicare ID - Type Unspecified