Healthcare Provider Details

I. General information

NPI: 1811151996
Provider Name (Legal Business Name): STEPHEN RUSSELL PATTEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SE HOSPITAL AVE
STUART FL
34994-2338
US

IV. Provider business mailing address

PO BOX 3168
INDIANAPOLIS IN
46206-3168
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-5200
  • Fax:
Mailing address:
  • Phone: 855-251-1854
  • Fax: 855-270-9738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.098619
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME97429
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: