Provider Demographics
NPI:1245276559
Name:PATTILLO, ALEXANDER FRASER III (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:FRASER
Last Name:PATTILLO
Suffix:III
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8800 SE SUNNYSIDE RD STE 300N
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5703
Mailing Address - Country:US
Mailing Address - Phone:281-286-2999
Mailing Address - Fax:512-607-4893
Practice Address - Street 1:2523 5TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3303
Practice Address - Country:US
Practice Address - Phone:205-322-8790
Practice Address - Fax:205-322-8713
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
AL4004237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-32916OtherBLUE CROSS BLUE SHIELD