Provider Demographics
NPI:1215060207
Name:PATTESON, PAT KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:PAT
Middle Name:KEITH
Last Name:PATTESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13409 GEORGE ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230
Mailing Address - Country:US
Mailing Address - Phone:210-492-8922
Mailing Address - Fax:210-479-2010
Practice Address - Street 1:13409 GEORGE ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230
Practice Address - Country:US
Practice Address - Phone:210-492-8922
Practice Address - Fax:210-479-2010
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM9572207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1946857-02OtherMEDICAID CSHCN
TX1946857-01Medicaid
TX1946857-02OtherMEDICAID CSHCN