Provider Demographics
NPI:1710974324
Name:PATTON, MARCUS (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:PATTON
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:PO BOX 2020
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-2020
Mailing Address - Country:US
Mailing Address - Phone:270-782-9994
Mailing Address - Fax:270-842-5048
Practice Address - Street 1:1725 ASHLEY CIR
Practice Address - Street 2:SUITE 209A
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3337
Practice Address - Country:US
Practice Address - Phone:270-782-9994
Practice Address - Fax:270-842-5048
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15539207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64155393Medicaid
KY1275802Medicare ID - Type Unspecified
KYC73550Medicare UPIN