Provider Demographics
NPI:1255347431
Name:PATTERSON, CARROLL DEAN (MD)
Entity type:Individual
Prefix:MR
First Name:CARROLL
Middle Name:DEAN
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:115 BLUE JAY DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068
Mailing Address - Country:US
Mailing Address - Phone:816-792-3220
Mailing Address - Fax:816-792-3422
Practice Address - Street 1:115 BLUE JAY DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068
Practice Address - Country:US
Practice Address - Phone:816-792-3220
Practice Address - Fax:816-792-3422
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO302052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11284014OtherBCBS OF KANSAS CITY
C50247Medicare UPIN
MO11284014OtherBCBS OF KANSAS CITY