Provider Demographics
NPI:1801890454
Name:PATTON, JERRY D (DO)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:D
Last Name:PATTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1205 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-3114
Mailing Address - Country:US
Mailing Address - Phone:918-938-0040
Mailing Address - Fax:918-938-0056
Practice Address - Street 1:1205 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-3114
Practice Address - Country:US
Practice Address - Phone:918-938-0040
Practice Address - Fax:918-938-0056
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK700549OtherMEDICARE
OK100251820EMedicaid
OK826011860OtherRAILROAD MEDICARE
OKE09745Medicare UPIN