Provider Demographics
NPI:1295746543
Name:PATTISON, CHARLES PHILLIP (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PHILLIP
Last Name:PATTISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7230 RENNER RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9901
Mailing Address - Country:US
Mailing Address - Phone:913-962-2122
Mailing Address - Fax:913-962-2422
Practice Address - Street 1:6080 N OAK TRFY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-5165
Practice Address - Country:US
Practice Address - Phone:816-221-9898
Practice Address - Fax:913-962-2422
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5912207RG0100X
KS0414738207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOK333635AMedicare PIN
C51052Medicare UPIN