Provider Demographics
NPI:1649238569
Name:PATTERSON, C. STEPHEN (MD)
Entity Type:Individual
Prefix:MR
First Name:C.
Middle Name:STEPHEN
Last Name:PATTERSON
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 1:1122 NW GARDEN VALLEY BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1930
Mailing Address - Country:US
Mailing Address - Phone:541-673-2455
Mailing Address - Fax:541-673-2456
Practice Address - Street 1:1122 NW GARDEN VALLEY BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1930
Practice Address - Country:US
Practice Address - Phone:541-673-2455
Practice Address - Fax:541-673-2456
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMDO7948174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR013441Medicaid
OR013441Medicaid
ORC93492Medicare UPIN