Healthcare Provider Details

I. General information

NPI: 1114967163
Provider Name (Legal Business Name): CRAIG P PATTEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 NORTH 500 WEST
PROVO UT
84604
US

IV. Provider business mailing address

PO BOX 10
SPANISH FORK UT
84660-0010
US

V. Phone/Fax

Practice location:
  • Phone: 801-373-7850
  • Fax:
Mailing address:
  • Phone: 866-898-7136
  • Fax: 616-975-9827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number2785521205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier930085777
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 2
IdentifierP00395947
Identifier TypeOTHER
Identifier State
Identifier IssuerRR MEDICARE
# 3
Identifier107005683103
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerSELECT HEALTH
# 4
IdentifierD3067
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer
# 5
Identifier94278552104001
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerBCBS
# 6
Identifier94278552105001
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerBCBS
# 7
Identifier94278552100001
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerBCBS
# 8
Identifier870492357PA1
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerEDUCATORS MUTUAL
# 9
Identifier870636000PAT
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerEDUCATORS MUTUAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: