Provider Demographics
NPI:1942317276
Name:PATTERSON, MARK LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEWIS
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-284-4517
Mailing Address - Fax:813-405-3722
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6353
Practice Address - Country:US
Practice Address - Phone:813-397-5300
Practice Address - Fax:813-726-0358
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43889207Q00000X
IL036100830207Q00000X
FLME100168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00447206OtherRR MEDICARE
FL01151OtherBCBS
FL01151OtherBCBS
FL279695300Medicaid
FL3777100001Medicare NSC
FLP00447206OtherRR MEDICARE
FLH53401Medicare UPIN
FLAH138VMedicare PIN
FL01151OtherBCBS
FLAH138ZMedicare PIN
FLAH138TMedicare PIN
FLAH138YMedicare PIN