Provider Demographics
NPI:1861627820
Name:PATTERSON, WILLIAM (IDMT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:431 MEADOWLARK RD
Mailing Address - Street 2:
Mailing Address - City:SHAW AFB
Mailing Address - State:SC
Mailing Address - Zip Code:29152
Mailing Address - Country:US
Mailing Address - Phone:803-895-6745
Mailing Address - Fax:803-895-6030
Practice Address - Street 1:431 MEADOWLARK ST
Practice Address - Street 2:
Practice Address - City:SHAW A F B
Practice Address - State:SC
Practice Address - Zip Code:29152-5019
Practice Address - Country:US
Practice Address - Phone:803-895-6745
Practice Address - Fax:803-895-6030
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians