Healthcare Provider Details

I. General information

NPI: 1568653269
Provider Name (Legal Business Name): JOHN PATTERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11680 PEBBLE HILLS BLVD STE 107
EL PASO TX
79936-1091
US

IV. Provider business mailing address

11680 PEBBLE HILLS BLVD SUITE 107
EL PASO TX
79936-1090
US

V. Phone/Fax

Practice location:
  • Phone: 915-219-9434
  • Fax: 833-989-2229
Mailing address:
  • Phone: 915-262-2039
  • Fax: 833-989-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBT#2341066-4005
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberN6958
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: