Provider Demographics
NPI:1700859691
Name:PATTERSON, BYRON OLIVER (MD)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:OLIVER
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:18411 CLARK ST
Mailing Address - Street 2:302
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3506
Mailing Address - Country:US
Mailing Address - Phone:818-501-7276
Mailing Address - Fax:818-501-7288
Practice Address - Street 1:18411 CLARK ST
Practice Address - Street 2:SUITE 302
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3506
Practice Address - Country:US
Practice Address - Phone:818-501-7276
Practice Address - Fax:818-501-7288
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA0625102080S0010X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG69035Medicare UPIN