Provider Demographics
NPI:1063731628
Name:PATTEN, PATRICK PARK (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:PARK
Last Name:PATTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAT
Other - Middle Name:
Other - Last Name:PATTEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-434-3626
Mailing Address - Fax:251-445-2464
Practice Address - Street 1:2451 UNIVERSITY HOSPITAL DRIVE
Practice Address - Street 2:MASTIN 102
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-470-5890
Practice Address - Fax:251-471-7925
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL342032085R0204X
LAMD.205469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine