Healthcare Provider Details

I. General information

NPI: 1578545109
Provider Name (Legal Business Name): ROBERT GREG PATTERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 CENTRAL AVE SUITE 1M07
EIELSON AFB AK
99702-2325
US

IV. Provider business mailing address

2645 HOUGHTON HILL DR
NORTH POLE AK
99705-6572
US

V. Phone/Fax

Practice location:
  • Phone: 907-377-1847
  • Fax: 907-377-0140
Mailing address:
  • Phone: 907-488-9085
  • Fax: 907-377-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01048153A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9685171-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: