Healthcare Provider Details

I. General information

NPI: 1780210708
Provider Name (Legal Business Name): VICTORIA SUSAN PATTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 JACK STEPHENS DR
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-8522
  • Fax: 501-603-1550
Mailing address:
  • Phone: 501-686-8000
  • Fax: 501-526-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-20783
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: