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NPI Code Detail

MEDICARE: DR. JERRY D. PATTON DO

MEDICARE: DR. JERRY D. PATTON DO
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
1207Q00000XFamily Medicine Physician1872OK

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OK700549OTHEROKMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801890454
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JERRY D. PATTON DO
Provider Business Mailing Address
First Line : 1205 W MAIN ST
Second Line :
City : COLLINSVILLE
State : OK
Zip : 74021-3114
Country : US
Telephone Number : 918-938-0040
Fax Number : 918-938-0056
Provider Business Practice Location Address
First Line : 1205 W MAIN ST
Second Line :
City : COLLINSVILLE
State : OK
Zip : 74021-3114
Country : US
Telephone Number : 918-938-0040
Fax Number : 918-938-0056
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 02/12/2019

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Directions to “ DR. JERRY D. PATTON DO” Practice Location

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