Provider Demographics
NPI:1720213770
Name:PATTON, EDDIE L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:L
Last Name:PATTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6400 FANNIN ST STE 2070
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1541
Mailing Address - Country:US
Mailing Address - Phone:713-704-6731
Mailing Address - Fax:713-704-6889
Practice Address - Street 1:929 GESSNER RD STE 2410
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2584
Practice Address - Country:US
Practice Address - Phone:713-486-7720
Practice Address - Fax:713-486-7744
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN46562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035TDOtherBCBSTX GRP PROVIDER RECORD NUMBER
TX284210601Medicaid
TXP01089607OtherRR MEDICARE
TX1720213770OtherBLUE CROSS BLUE SHIELD
TX284210602Medicaid
TXP01254967OtherMEDICARE RR
TX00106WOtherMDCR GRP PTAN NUMBER
TX153449704Medicaid