Healthcare Provider Details

I. General information

NPI: 1366402778
Provider Name (Legal Business Name): CHRISTOPHER M PATTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 SW RAMSEY AVE
GRANTS PASS OR
97527-5681
US

IV. Provider business mailing address

495 SW RAMSEY AVE
GRANTS PASS OR
97527-5681
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-6644
  • Fax: 541-472-5673
Mailing address:
  • Phone: 541-476-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD191825
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500760439
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: