Healthcare Provider Details

I. General information

NPI: 1508469370
Provider Name (Legal Business Name): DR. CHAD EVAN PATTERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 GAULT AVE N
FORT PAYNE AL
35967-3418
US

IV. Provider business mailing address

1916 GAULT AVE N
FORT PAYNE AL
35967-3418
US

V. Phone/Fax

Practice location:
  • Phone: 256-845-2004
  • Fax: 256-845-7839
Mailing address:
  • Phone: 256-845-2004
  • Fax: 256-845-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16184
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: