Healthcare Provider Details

I. General information

NPI: 1063419794
Provider Name (Legal Business Name): JOHN M PATTERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MEDICAL HEIGHTS DR
FRANKFORT KY
40601-4137
US

IV. Provider business mailing address

101 MEDICAL HEIGHTS DR STE A
FRANKFORT KY
40601-4137
US

V. Phone/Fax

Practice location:
  • Phone: 502-223-5758
  • Fax: 502-223-0047
Mailing address:
  • Phone: 502-223-5758
  • Fax: 502-223-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number23350
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: