Provider Demographics
NPI:1396729901
Name:PATTERSON, CRAIG P (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:P
Last Name:PATTERSON
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:PO BOX 20452
Mailing Address - Street 2:FML- CREDENTIALING
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0452
Mailing Address - Country:US
Mailing Address - Phone:614-457-8180
Mailing Address - Fax:614-442-2414
Practice Address - Street 1:1801 W 32ND ST BLDG B
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1528
Practice Address - Country:US
Practice Address - Phone:417-623-6330
Practice Address - Fax:417-623-3950
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD112305207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO700432206Medicaid
990008258OtherTRAVELERS
009010120Medicare PIN
990008258OtherTRAVELERS