Healthcare Provider Details

I. General information

NPI: 1063659134
Provider Name (Legal Business Name): DAVID J. PATTON, MD., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 OAKHURST DR
CHARLESTON WV
25314-2044
US

IV. Provider business mailing address

1003 OAKHURST DR
CHARLESTON WV
25314-2044
US

V. Phone/Fax

Practice location:
  • Phone: 304-345-4525
  • Fax: 304-345-4527
Mailing address:
  • Phone: 304-345-4525
  • Fax: 304-345-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number18950
License Number StateWV

VIII. Authorized Official

Name: DR. DAVID JAMISON PATTON
Title or Position: OWNER
Credential: MD
Phone: 304-345-4525