Healthcare Provider Details

I. General information

NPI: 1508893124
Provider Name (Legal Business Name): MARY DEFFNER PATTERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD # 100186
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100186
GAINESVILLE FL
32610-0186
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-5911
  • Fax:
Mailing address:
  • Phone: 352-265-5911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME135760
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35.054632
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: