Provider Demographics
NPI:1942241526
Name:PATTON, RICHARD (RD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:PATTON
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 N FEDERAL HWY
Mailing Address - Street 2:300
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1998
Mailing Address - Country:US
Mailing Address - Phone:954-957-7171
Mailing Address - Fax:954-745-0501
Practice Address - Street 1:572 E MCNAB RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-9355
Practice Address - Country:US
Practice Address - Phone:954-527-9303
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLN1097133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist