MEDICARE: MARQUAND PATTON JR. D.O.

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	207RC0000X	Cardiovascular Disease Physician	OS019400	PA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207RI0011X	Interventional Cardiology Physician	OS12388	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457617516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUAND PATTON JR. D.O.

Provider Business Mailing Address
First Line	:	6233 W BEHREND DR
Second Line	:	2034
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6970
Country	:	US
Telephone Number	:	480-652-1695
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 SW 37TH AVE STE 901
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2751
Country	:	US
Telephone Number	:	305-285-7282
Fax Number	:	305-285-7114

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

Provider Enumeration Date	:	04/03/2012
Last Update Date	:	07/15/2019

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