Provider Demographics
NPI:1063447340
Name:PATTON, JOHN DALE (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DALE
Last Name:PATTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 316
Mailing Address - Street 2:991 BALEN HAZEN RD
Mailing Address - City:RYEGATE
Mailing Address - State:VT
Mailing Address - Zip Code:05042
Mailing Address - Country:US
Mailing Address - Phone:802-584-3928
Mailing Address - Fax:
Practice Address - Street 1:991 BALEN HAZEN RD
Practice Address - Street 2:
Practice Address - City:RYEGATE
Practice Address - State:VT
Practice Address - Zip Code:05042
Practice Address - Country:US
Practice Address - Phone:802-584-3928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9255208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007010Medicaid
VT1007131Medicaid