Provider Demographics
NPI:1639735947
Name:PATTON, CODY ROBERT (SO-IDC)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:ROBERT
Last Name:PATTON
Suffix:
Gender:M
Credentials:SO-IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3RD MARINE RAIDER BATTALION
Mailing Address - Street 2:PSC BOX 20073
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542
Mailing Address - Country:US
Mailing Address - Phone:910-440-1788
Mailing Address - Fax:
Practice Address - Street 1:3RD MARINE RAIDER BATTALION
Practice Address - Street 2:BLDG 614
Practice Address - City:CAMP LEJEUNE, NC
Practice Address - State:NC
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:517-748-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman