Provider Demographics
NPI:1376629816
Name:SAAVEDRA, PATRICK M (DPM)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
Last Name:SAAVEDRA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2765 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1828
Mailing Address - Country:US
Mailing Address - Phone:423-764-2299
Mailing Address - Fax:423-968-3340
Practice Address - Street 1:616 CAMPUS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9699
Practice Address - Country:US
Practice Address - Phone:423-764-2299
Practice Address - Fax:423-968-3340
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301055213E00000X
TNDPM0000000720213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4310812OtherBLUE CROSS OF TN
VA1376629816Medicaid
TN2190472Medicaid
VAVV4170AMedicare PIN
TNSA4027741Medicare PIN