Provider Demographics
NPI:1700880135
Name:PATTERSON, BRIAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2279
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-2279
Mailing Address - Country:US
Mailing Address - Phone:805-466-6622
Mailing Address - Fax:805-461-0361
Practice Address - Street 1:7700 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4435
Practice Address - Country:US
Practice Address - Phone:805-466-6622
Practice Address - Fax:805-461-0361
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35558208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
4935280014OtherCIGNA PIN
CA00G355580OtherBLUE SHIELD OF CA PIN
CA00G355580Medicaid
4301791OtherAETNA PIN
CAG35558OtherMEDICAL LICENSE #