Provider Demographics
NPI:1811151996
Name:PATTEN, STEPHEN RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RUSSELL
Last Name:PATTEN
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 3168
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3168
Mailing Address - Country:US
Mailing Address - Phone:855-251-1854
Mailing Address - Fax:855-270-9738
Practice Address - Street 1:300 SE HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2338
Practice Address - Country:US
Practice Address - Phone:772-287-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0986192085R0202X
FLME974292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04R56OtherBC BS OF FLORIDA
OH204881619OtherKAISER
OH9213893OtherAETNA
FL009161600Medicaid
OH0064106Medicaid
OH204881619259OtherCARESOURCE
FLHK323ZOtherMEDICARE