Basic Information
| Provider Information | |||||||||
| NPI: | 1447231196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATTON | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23340 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631563340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148385702 | ||||||||
| FaxNumber: | 3148395596 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 GRAHAM RD | ||||||||
| Address2: | SUITE C-1330 | ||||||||
| City: | FLORISSANT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630318012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148385702 | ||||||||
| FaxNumber: | 3148395596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 10/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 104031 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5088146 | 01 | MO | AETNA | OTHER | 000000010028 | 01 | MO | ESSENCE | OTHER | 265223 | 01 | MO | HEALTHLINK | OTHER | G33244 | 01 | MO | MERCY | OTHER | 106639 | 01 | MO | BCBS | OTHER | 0400909 | 01 | MO | UHC | OTHER | 0400813 | 01 | UHC MEDICARE COMPLETE | OTHER | 127473 | 01 | MO | GHP | OTHER |