Healthcare Provider Details

I. General information

NPI: 1326308305
Provider Name (Legal Business Name): JERRY W. PATTERSON, D.P.M, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 TREELINE PARK SUITE 315
SAN ANTONIO TX
78209-2060
US

IV. Provider business mailing address

423 TREELINE PARK SUITE 315
SAN ANTONIO TX
78209-2060
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-9610
  • Fax: 210-614-9613
Mailing address:
  • Phone: 210-614-9610
  • Fax: 210-614-9613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0457
License Number StateTX

VIII. Authorized Official

Name: ELIZABETH ARDOIN
Title or Position: BILLING MANAGER
Credential:
Phone: 210-614-9610