Healthcare Provider Details

I. General information

NPI: 1649238569
Provider Name (Legal Business Name): C. STEPHEN PATTERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 NW GARDEN VALLEY BLVD SUITE 107
ROSEBURG OR
97470-1930
US

IV. Provider business mailing address

1122 NW GARDEN VALLEY BLVD SUITE 107
ROSEBURG OR
97470-1930
US

V. Phone/Fax

Practice location:
  • Phone: 541-673-2455
  • Fax: 541-673-2456
Mailing address:
  • Phone: 541-673-2455
  • Fax: 541-673-2456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMDO7948
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: