Provider Demographics
NPI:1629098355
Name:PATTERSON, TONI R (DO)
Entity type:Individual
Prefix:DR
First Name:TONI
Middle Name:R
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TONI
Other - Middle Name:R
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:351 CONSORT DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4439
Mailing Address - Country:US
Mailing Address - Phone:636-200-4242
Mailing Address - Fax:636-200-4243
Practice Address - Street 1:17050 BAXTER RD
Practice Address - Street 2:DEPT. OF ANESTHESIA
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1422
Practice Address - Country:US
Practice Address - Phone:636-200-4242
Practice Address - Fax:636-200-4243
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1A25207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241494731Medicaid
IA0976845Medicaid
MO8298OtherHEALTHCARE USA (GROUP)
CG4336OtherRAILROAD MEDICARE
IA1909887Medicaid
050055115OtherRAILROAD MEDICARE
MO80171OtherHEALTHCARE USA
001011631Medicare ID - Type Unspecified
MO8298OtherHEALTHCARE USA (GROUP)
MOD41774Medicare UPIN