Provider Demographics
NPI:1063419794
Name:PATTERSON, JOHN M (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:101 MEDICAL HEIGHTS DR
Mailing Address - Street 2:STE A
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4137
Mailing Address - Country:US
Mailing Address - Phone:502-223-5758
Mailing Address - Fax:502-223-0047
Practice Address - Street 1:101 MEDICAL HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4137
Practice Address - Country:US
Practice Address - Phone:502-223-5758
Practice Address - Fax:502-223-0047
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23350208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64233505Medicaid
KY0383202Medicare PIN
KY0169Medicare PIN
KYC75665Medicare UPIN
KY340012658Medicare PIN
KYP400039043Medicare PIN