Provider Demographics
NPI:1215931753
Name:PATTERSON, STUART DREW (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:DREW
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 1:2000 E EDGEWOOD DR
Mailing Address - Street 2:STE 112
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3639
Mailing Address - Country:US
Mailing Address - Phone:863-666-3436
Mailing Address - Fax:863-667-3550
Practice Address - Street 1:2000 E EDGEWOOD DR
Practice Address - Street 2:STE 112
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3639
Practice Address - Country:US
Practice Address - Phone:863-666-3436
Practice Address - Fax:863-667-3550
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2013-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
FLME76265174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7287263OtherAETNA
FL43865OtherBCBS OF FL PROV #
FL6419019001OtherCIGNA PROV #
FL1994OtherAVMED
FL1844429OtherUHC PROV #
FLP00155084Medicare ID - Type UnspecifiedRAILROAD MCR IND PROV #
FLK5239Medicare ID - Type UnspecifiedMEDICARE GROUP #
FL6419019001OtherCIGNA PROV #
FLDC2168Medicare ID - Type UnspecifiedRAILROAD MCR GRP PROV #
FL43865YMedicare ID - Type UnspecifiedMEDICARE IND PROVIDER #
FL7287263OtherAETNA