Provider Demographics
NPI:1942474721
Name:PATTERSON, ELTANYA A (MD)
Entity Type:Individual
Prefix:DR
First Name:ELTANYA
Middle Name:A
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELTANYA
Other - Middle Name:ANGELITA
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:18121 NW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4215
Mailing Address - Country:US
Mailing Address - Phone:305-308-6823
Mailing Address - Fax:
Practice Address - Street 1:449 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4507
Practice Address - Country:US
Practice Address - Phone:850-769-8341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115754208M00000X, 207Q00000X
WV27936208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000665896OtherANTHEM BCBS KY
KY7100118510Medicaid
KY7100118510Medicaid