Provider Demographics
NPI:1861459463
Name:PATTERSON, TODD A (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 CLINE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0812
Mailing Address - Country:US
Mailing Address - Phone:850-222-4801
Mailing Address - Fax:850-222-4801
Practice Address - Street 1:111 S MAGNOLIA DR
Practice Address - Street 2:SUITE 10
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2973
Practice Address - Country:US
Practice Address - Phone:850-878-5322
Practice Address - Fax:850-878-3120
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS48022080N0001X, 208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC36474Medicare UPIN