Provider Demographics
NPI:1619995198
Name:PATTERSON, JAMES CLIFTON (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CLIFTON
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 33392 1501 KINGS HIGHWAY
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3932
Mailing Address - Country:US
Mailing Address - Phone:318-675-6042
Mailing Address - Fax:318-675-6148
Practice Address - Street 1:1501 KINGS HIGHWAY
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3932
Practice Address - Country:US
Practice Address - Phone:318-675-6042
Practice Address - Fax:318-675-6148
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13659R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1431788Medicaid
LA5H564F600Medicare ID - Type Unspecified
LA5H564Medicare PIN
LA1431788Medicaid