Provider Demographics
NPI:1881647824
Name:PATTY, CARL F (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:F
Last Name:PATTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2210 BARRON RD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-1908
Mailing Address - Country:US
Mailing Address - Phone:573-686-4133
Mailing Address - Fax:573-778-1099
Practice Address - Street 1:2210 BARRON RD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-1908
Practice Address - Country:US
Practice Address - Phone:573-686-4133
Practice Address - Fax:573-778-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR8B19207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201645538Medicaid
MO520314128Medicare PIN
MOP00085349Medicare PIN
MO201645538Medicaid