Healthcare Provider Details

I. General information

NPI: 1568436913
Provider Name (Legal Business Name): WALTER STINNETT PATTON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 E HAMPTON ST
TUCSON AZ
85712-2919
US

IV. Provider business mailing address

5550 E HAMPTON ST
TUCSON AZ
85712-2919
US

V. Phone/Fax

Practice location:
  • Phone: 520-721-8605
  • Fax: 520-721-4209
Mailing address:
  • Phone: 520-721-8605
  • Fax: 520-721-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number12157
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: