Healthcare Provider Details

I. General information

NPI: 1760477244
Provider Name (Legal Business Name): DENZIL DEAN PATTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HEART DRIVE ECU PHYSICIANS FAMILY PRACTICE CENTER
GREENVILLE NC
27834-8944
US

IV. Provider business mailing address

PO BOX 751069 ECU PHYSICIANS FAMILY MEDICINE
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-4611
  • Fax: 252-744-2056
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30078
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: