Provider Demographics
NPI:1063437283
Name:PATTON, MARK A (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:PATTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4204
Mailing Address - Country:US
Mailing Address - Phone:503-362-9334
Mailing Address - Fax:503-362-8016
Practice Address - Street 1:1234 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4204
Practice Address - Country:US
Practice Address - Phone:503-362-9334
Practice Address - Fax:503-362-8016
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO17917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR058219Medicaid
OR132609Medicare ID - Type Unspecified
OR058219Medicaid