MEDICARE: MRS. PATRICIA ANN PAGAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35849	TN
2	207Q00000X	Family Medicine Physician	3583	SD
3	2083P0901X	Public Health & General Preventive Medicine Physician	35849	TN
4	2083P0901X	Public Health & General Preventive Medicine Physician	3583	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4041838	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1780668426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA ANN PAGAN MD

Provider Business Mailing Address
First Line	:	108 LIFESTYLE WAY
Second Line	:
City	:	BENTON
State	:	TN
Zip	:	37307-3914
Country	:	US
Telephone Number	:	423-338-7777
Fax Number	:	423-338-9326

Provider Business Practice Location Address
First Line	:	108 LIFESTYLE WAY
Second Line	:
City	:	BENTON
State	:	TN
Zip	:	37307-3914
Country	:	US
Telephone Number	:	423-338-7777
Fax Number	:	423-338-9326

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	09/11/2025

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