Provider Demographics
NPI:1952405177
Name:PATTERSON, DARRYLL R (MD)
Entity type:Individual
Prefix:
First Name:DARRYLL
Middle Name:R
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 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-5123
Mailing Address - Fax:
Practice Address - Street 1:6130 PLUMAS ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-6060
Practice Address - Country:US
Practice Address - Phone:775-327-5000
Practice Address - Fax:775-327-5050
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15392207R00000X
OH35.142859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4384210Medicaid
OHPENDINGMedicaid
MI4384210Medicaid