Healthcare Provider Details

I. General information

NPI: 1609830447
Provider Name (Legal Business Name): ALONZO PATTERSON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1152 W 3RD ST
DAYTON OH
45402-6847
US

IV. Provider business mailing address

PO BOX 933432
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-3483
  • Fax: 937-268-1884
Mailing address:
  • Phone: 937-641-5072
  • Fax: 937-641-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35060175P
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: