Healthcare Provider Details

I. General information

NPI: 1063447340
Provider Name (Legal Business Name): JOHN DALE PATTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 BALEN HAZEN RD
RYEGATE VT
05042
US

IV. Provider business mailing address

BOX 316 991 BALEN HAZEN RD
RYEGATE VT
05042
US

V. Phone/Fax

Practice location:
  • Phone: 802-584-3928
  • Fax:
Mailing address:
  • Phone: 802-584-3928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9255
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: