MEDICARE: DWAYNE E PATTERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	9700702	NC
2	208100000X	Physical Medicine & Rehabilitation Physician	97-00702	NC

General Provider Information

NPI Number	:	1255334934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DWAYNE E PATTERSON MD

Provider Business Mailing Address
First Line	:	7101 CREEDMOOR RD STE 109
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1682
Country	:	US
Telephone Number	:	919-324-1704
Fax Number	:	919-516-0070

Provider Business Practice Location Address
First Line	:	7101 CREEDMOOR RD STE 109
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1682
Country	:	US
Telephone Number	:	919-324-1704
Fax Number	:	919-516-0070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/05/2021

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