Provider Demographics
NPI:1356322135
Name:PATTERSON, PATTI J (MD)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:J
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3601 4TH ST FL 3
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:806-743-7335
Practice Address - Fax:806-743-4073
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3677208000000X, 2080C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136924109Medicaid
TX84212ZOtherHMO BLUE
TX121171101OtherFIRSTCARE COMMERCIAL
TX121171100Medicaid
TX136924110Medicaid
NM66551Medicaid
OK100149250AMedicaid
TX87192GOtherBC/BS
NMA377OtherTRIWEST
NMA377OtherTRIWEST
TX87192GOtherBC/BS
TX84212ZOtherHMO BLUE