Provider Demographics
NPI:1255743787
Name:PATTON, BRADLEY (DO)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:PATTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 VILLAGE WAY STE 1A
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5116
Mailing Address - Country:US
Mailing Address - Phone:234-269-6300
Mailing Address - Fax:234-602-2721
Practice Address - Street 1:72 VILLAGE WAY STE 1A
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-5116
Practice Address - Country:US
Practice Address - Phone:234-269-6300
Practice Address - Fax:234-602-2721
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.012386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program