Provider Demographics
NPI:1255334934
Name:PATTERSON, DWAYNE E (MD)
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:E
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 1:7101 CREEDMOOR RD STE 109
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1682
Mailing Address - Country:US
Mailing Address - Phone:919-324-1704
Mailing Address - Fax:919-516-0070
Practice Address - Street 1:7101 CREEDMOOR RD STE 109
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1682
Practice Address - Country:US
Practice Address - Phone:919-324-1704
Practice Address - Fax:919-516-0070
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97007022081P2900X
NC97-00702208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G60126Medicare UPIN