Provider Demographics
NPI: | 1457617516 |
---|---|
Name: | PATTON, MARQUAND JR (DO) |
Entity Type: | Individual |
Prefix: | |
First Name: | MARQUAND |
Middle Name: | |
Last Name: | PATTON |
Suffix: | JR |
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: | 6233 W BEHREND DR |
Mailing Address - Street 2: | 2034 |
Mailing Address - City: | GLENDALE |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85308-6970 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-652-1695 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2601 SW 37TH AVE STE 901 |
Practice Address - Street 2: | |
Practice Address - City: | MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33133-2751 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-285-7282 |
Practice Address - Fax: | 305-285-7114 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2012-04-03 |
Last Update Date: | 2019-07-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | OS019400 | 207RC0000X |
390200000X | ||
FL | OS12388 | 207RI0011X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |