Healthcare Provider Details

I. General information

NPI: 1871971598
Provider Name (Legal Business Name): CRISTIAN PATTERSON D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6644 E BAYWOOD AVE
MESA AZ
85206
US

IV. Provider business mailing address

321 W MERRILL AVE
GILBERT AZ
85233-2133
US

V. Phone/Fax

Practice location:
  • Phone: 480-321-0183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number00000
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number007544
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: