Provider Demographics
NPI:1891805362
Name:PATCHETT, HOWARD TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:TIMOTHY
Last Name:PATCHETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:
Other - Last Name:PATCHETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3237 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2414
Mailing Address - Country:US
Mailing Address - Phone:530-885-8128
Mailing Address - Fax:530-885-0239
Practice Address - Street 1:3237 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2414
Practice Address - Country:US
Practice Address - Phone:530-885-8128
Practice Address - Fax:530-885-0239
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50465207W00000X
WAMD00024717207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G504650Medicaid
CAP00820204Medicare PIN
CACS483ZMedicare PIN
CA0925850001Medicare NSC