Healthcare Provider Details

I. General information

NPI: 1538513379
Provider Name (Legal Business Name): JASON MICHAEL PATTON M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 1ST ST
EMMETSBURG IA
50536-2516
US

IV. Provider business mailing address

621 S ILLINOIS AVE STE 103
MASON CITY IA
50401-5489
US

V. Phone/Fax

Practice location:
  • Phone: 712-852-5555
  • Fax: 712-852-5692
Mailing address:
  • Phone: 712-852-5555
  • Fax: 712-852-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-11019
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46234
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: