Basic Information
| Provider Information | |||||||||
| NPI: | 1598028433 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATTERSON | ||||||||
| FirstName: | SHANE | ||||||||
| MiddleName: | BURR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 MDG/SGOMB | ||||||||
| Address2: | 101 BODIN CIRCLE | ||||||||
| City: | TRAVIS AFB | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074233000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 60 MDG/SGOMB | ||||||||
| Address2: | 101 BODIN CIRCLE | ||||||||
| City: | TRAVIS AFB | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074233000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2012 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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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 | 0101255210 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208D00000X | 0101255210 | VA | N | Allopathic & Osteopathic Physicians | General Practice | 390200000X | 0101255210 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RI0200X | 0101255210 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.