Healthcare Provider Details

I. General information

NPI: 1932780137
Provider Name (Legal Business Name): SAMUEL LOGAN PATTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SE MOBERLY LN
BENTONVILLE AR
72712-7017
US

IV. Provider business mailing address

3317 N WIMBERLY DR
FAYETTEVILLE AR
72703-4056
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-2752
  • Fax: 479-443-7862
Mailing address:
  • Phone: 479-587-3149
  • Fax: 479-443-7862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberE-20837
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: