Provider Demographics
NPI:1063590677
Name:PATTERSON, MARK ALLEN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:PATTERSON
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:PO BOX 2493
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-0493
Mailing Address - Country:US
Mailing Address - Phone:925-954-8960
Mailing Address - Fax:
Practice Address - Street 1:2657 SAKLAN INDIAN DR APT 2
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-3026
Practice Address - Country:US
Practice Address - Phone:925-954-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G354000Medicaid
00G354000Medicare ID - Type Unspecified
CA00G354000Medicaid