Healthcare Provider Details

I. General information

NPI: 1912275538
Provider Name (Legal Business Name): PATTERSON GASTROENTEROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W BUCKEYE RD SUITE 105
PHOENIX AZ
85003-2647
US

IV. Provider business mailing address

PO BOX 90482
PHOENIX AZ
85066-0482
US

V. Phone/Fax

Practice location:
  • Phone: 602-283-3165
  • Fax: 602-283-3612
Mailing address:
  • Phone: 602-283-3165
  • Fax: 602-283-3612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number20901
License Number StateAZ

VIII. Authorized Official

Name: DR. EDWARD LEE PATTERSON JR.
Title or Position: OWNER/CEO
Credential: MEDICAL DOCTOR
Phone: 602-283-3165