Healthcare Provider Details

I. General information

NPI: 1255334934
Provider Name (Legal Business Name): DWAYNE E PATTERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 CREEDMOOR RD STE 109
RALEIGH NC
27613-1682
US

IV. Provider business mailing address

7101 CREEDMOOR RD STE 109
RALEIGH NC
27613-1682
US

V. Phone/Fax

Practice location:
  • Phone: 919-324-1704
  • Fax: 919-516-0070
Mailing address:
  • Phone: 919-324-1704
  • Fax: 919-516-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number9700702
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number97-00702
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: