Basic Information
| Provider Information | |||||||||
| NPI: | 1356322135 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATTERSON | ||||||||
| FirstName: | PATTI | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794085865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432898 | ||||||||
| FaxNumber: | 8067432787 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 4TH ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794300002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067437335 | ||||||||
| FaxNumber: | 8067434073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G3677 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080C0008X | G3677 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Child Abuse Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 136924109 | 05 | TX | MEDICAID | 84212Z | 01 | TX | HMO BLUE | OTHER | 121171101 | 01 | TX | FIRSTCARE COMMERCIAL | OTHER | 121171100 | 05 | TX | MEDICAID | 136924110 | 05 | TX | MEDICAID | 66551 | 05 | NM | MEDICAID | 100149250A | 05 | OK | MEDICAID | 87192G | 01 | TX | BC/BS | OTHER | A377 | 01 | NM | TRIWEST | OTHER |