Provider Demographics
NPI:1720001498
Name:PATTEN, RANDALL MALCOLM (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:MALCOLM
Last Name:PATTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-761-4201
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000227352085R0202X
WA00227352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0252323OtherLNI-UNION AVENUE OPEN MRI
WA1017229Medicaid
WA0401121OtherLNI-DIAGNOSTIC IMAGING NW
WA0401119OtherLNI-TRA MEDICAL IMAGING-KING
WA0249080OtherLNI-TRA MEDICAL IMAGING-PIERCE
WA0252311OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WAG8883544OtherPTAN-MIO1
WAG8883962OtherPTAN-UAOM