Provider Demographics
NPI:1952341190
Name:PATTERSON, NATHAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:W
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 1:543 FONTAINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2058
Mailing Address - Country:US
Mailing Address - Phone:850-934-3756
Mailing Address - Fax:850-934-6638
Practice Address - Street 1:543 FONTAINE ST STE A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2058
Practice Address - Country:US
Practice Address - Phone:850-476-3223
Practice Address - Fax:850-476-1948
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME916842086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7359638OtherAETNA ID #
FL52014OtherBC/BS ID #
FL591-74687OtherBC/BS OF AL ID #
FL591-74687OtherBC/BS OF AL ID #
FL52014YMedicare ID - Type Unspecified