Provider Demographics
NPI:1851618276
Name:JOHN PATTERSON, MD, PA
Entity Type:Organization
Organization Name:JOHN PATTERSON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-219-9434
Mailing Address - Street 1:11680 PEBBLE HILLS BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-1091
Mailing Address - Country:US
Mailing Address - Phone:915-262-2039
Mailing Address - Fax:833-989-2229
Practice Address - Street 1:11680 PEBBLE HILLS BLVD STE 107
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-1091
Practice Address - Country:US
Practice Address - Phone:915-219-9434
Practice Address - Fax:833-989-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-24
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2168007-01Medicaid