Healthcare Provider Details

I. General information

NPI: 1952341190
Provider Name (Legal Business Name): NATHAN W. PATTERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 FONTAINE ST STE A
PENSACOLA FL
32503-2058
US

IV. Provider business mailing address

543 FONTAINE ST STE A
PENSACOLA FL
32503-2058
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-3223
  • Fax: 850-476-1948
Mailing address:
  • Phone: 850-934-3756
  • Fax: 850-934-6638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME91684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: