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General NPI Number Information
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NPI Number | 1912275538
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Entity Type | Organization
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Legal Business Name | PATTERSON GASTROENTEROLOGY PLLC
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Dates
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Enumeration Date | 12/09/2011
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Last Update Date | 12/09/2011
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Provider Practice Location Address
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Address Line | 515 W BUCKEYE RD SUITE 105
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City | PHOENIX
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State | AZ
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Zip | 85003-2647
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Country | US
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Telephone | 602-283-3165
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Fax | 602-283-3612
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Provider Business Mailing Address
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Address Line | PO BOX 90482
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City | PHOENIX
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State | AZ
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Zip | 85066-0482
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Country | US
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Telephone | 602-283-3165
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Fax | 602-283-3612
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. EDWARD LEE PATTERSON JR.
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Credential | MEDICAL DOCTOR
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Telephone | 602-283-3165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 20901
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License Number State | AZ
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