Provider Demographics
NPI:1922078500
Name:STERRETT, PATRICK RAY (MD, PHD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:RAY
Last Name:STERRETT
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7800
Mailing Address - Country:US
Mailing Address - Phone:563-583-4000
Mailing Address - Fax:563-557-1016
Practice Address - Street 1:3405 LAKE RIDGE DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7800
Practice Address - Country:US
Practice Address - Phone:563-583-4000
Practice Address - Fax:563-557-1016
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA229822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2193771Medicaid
IA2193771Medicaid
IAAO1969Medicare UPIN