Provider Demographics
NPI:1649443672
Name:GREGORY A PATCHEN DO PC
Entity type:Organization
Organization Name:GREGORY A PATCHEN DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-839-5800
Mailing Address - Street 1:1953 S COMANCHE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6466
Mailing Address - Country:US
Mailing Address - Phone:480-839-5800
Mailing Address - Fax:480-839-5804
Practice Address - Street 1:2058 S DOBSON RD
Practice Address - Street 2:SUITE 15
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6454
Practice Address - Country:US
Practice Address - Phone:480-839-5800
Practice Address - Fax:480-839-5804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ2996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ826429Medicare PIN
AZE67923Medicare UPIN