Healthcare Provider Details

I. General information

NPI: 1427046432
Provider Name (Legal Business Name): ROBERT LEWIS PATTERSON III PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 UNION AVE FL 2
GRANTS PASS OR
97527-5543
US

IV. Provider business mailing address

2825 E BARNETT RD # MSS
MEDFORD OR
97504-8332
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-4200
  • Fax:
Mailing address:
  • Phone: 541-789-4200
  • Fax: 541-507-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00756
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-00756
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA00756
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: