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General NPI Number Information
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NPI Number | 1396963989
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Entity Type | Individual
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Provider Name | WILEY ALEXANDER PATTERSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10200 BROADWAY ST
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City | SAN ANTONIO
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State | TX
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Zip | 78217-4431
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Country | US
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Telephone | 210-654-3192
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Fax | 210-654-3731
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Provider Business Mailing Address
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Address Line | PO BOX 15613
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City | SAN ANTONIO
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State | TX
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Zip | 78212-8813
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Country | US
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Telephone | 210-349-2390
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Fax | 210-614-9109
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G1745
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License Number State | TX
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