Healthcare Provider Details

I. General information

NPI: 1235178963
Provider Name (Legal Business Name): GEORGE PATTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9146 HIGHWAY 63 N
BONO AR
72416-8153
US

IV. Provider business mailing address

9146 HIGHWAY 63 N C/O HOUSE MEDICAL CLINIC
BONO AR
72416-8153
US

V. Phone/Fax

Practice location:
  • Phone: 870-930-9990
  • Fax: 870-930-9992
Mailing address:
  • Phone: 870-930-9990
  • Fax: 870-930-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3180
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: