MEDICARE: DENNIS R PATTON M.D.

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	207R00000X	Internal Medicine Physician	104031	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	0400813	OTHER		UHC MEDICARE COMPLETE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5088146	OTHER	MO	AETNA
2	000000010028	OTHER	MO	ESSENCE
3	265223	OTHER	MO	HEALTHLINK
4	G33244	OTHER	MO	MERCY
5	106639	OTHER	MO	BCBS
6	0400909	OTHER	MO	UHC
8	127473	OTHER	MO	GHP

General Provider Information

NPI Number	:	1447231196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS R PATTON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 23340
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63156-3340
Country	:	US
Telephone Number	:	314-838-5702
Fax Number	:	314-839-5596

Provider Business Practice Location Address
First Line	:	1225 GRAHAM RD
Second Line	:	SUITE C-1330
City	:	FLORISSANT
State	:	MO
Zip	:	63031-8012
Country	:	US
Telephone Number	:	314-838-5702
Fax Number	:	314-839-5596

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	10/24/2012

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Directions to “ DENNIS R PATTON M.D.” Practice Location

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