Provider Demographics
NPI:1801170816
Name:J. GABRIELLE P. PATTERSON M.D., P.A.
Entity type:Organization
Organization Name:J. GABRIELLE P. PATTERSON M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:GABRIELLE
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-498-8670
Mailing Address - Street 1:403 W CAMPBELL RD STE 410
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3466
Mailing Address - Country:US
Mailing Address - Phone:972-498-8670
Mailing Address - Fax:972-498-8676
Practice Address - Street 1:403 W CAMPBELL RD STE 410
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3466
Practice Address - Country:US
Practice Address - Phone:972-498-8670
Practice Address - Fax:972-498-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5653207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH19008Medicare UPIN