Healthcare Provider Details

I. General information

NPI: 1215060207
Provider Name (Legal Business Name): PAT KEITH PATTESON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13409 GEORGE ROAD
SAN ANTONIO TX
78230
US

IV. Provider business mailing address

13409 GEORGE ROAD
SAN ANTONIO TX
78230
US

V. Phone/Fax

Practice location:
  • Phone: 210-492-8922
  • Fax: 210-479-2010
Mailing address:
  • Phone: 210-492-8922
  • Fax: 210-479-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM9572
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: