Basic Information
| Provider Information | |||||||||
| NPI: | 1801108873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATTON | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15518 ECHO LN | ||||||||
| Address2: | |||||||||
| City: | SELMA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781541868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022127140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3551 ROGER BROOKE DR | ||||||||
| Address2: | |||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109164141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2010 | ||||||||
| LastUpdateDate: | 08/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 26437 | NE | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | S8894 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.