Healthcare Provider Details

I. General information

NPI: 1134111941
Provider Name (Legal Business Name): GWYNN RAWDING PATTERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 04/10/2006

III. Provider practice location address

4990 E MEDITERRANEAN DR SUITE C
SIERRA VISTA AZ
85635-2494
US

IV. Provider business mailing address

4990 E MEDITERRANEAN DR SUITE C
SIERRA VISTA AZ
85635-2494
US

V. Phone/Fax

Practice location:
  • Phone: 520-417-2229
  • Fax: 520-417-2266
Mailing address:
  • Phone: 520-417-2229
  • Fax: 520-417-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number14904
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14904
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: