Provider Demographics
NPI:1790719078
Name:PATTERSON, MICHAEL SMITH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SMITH
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 1:2590 CAMINO ENTRADA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4876
Mailing Address - Country:US
Mailing Address - Phone:505-946-3233
Mailing Address - Fax:505-946-3234
Practice Address - Street 1:2590 CAMINO ENTRADA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4876
Practice Address - Country:US
Practice Address - Phone:505-946-3233
Practice Address - Fax:505-946-3234
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM90-270208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
202010446OtherPRESBYTERIAN HEALTH PLAN
10001079OtherLOVELACE
2714991OtherUHC
NMNM029F60OtherBCBS NM
PROVP15511OtherMOLINA
NM33146Medicaid
NM346702501Medicare PIN
10001079OtherLOVELACE