Provider Demographics
NPI:1215974209
Name:PATCHEN, GREGORY A (DO PC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:PATCHEN
Suffix:
Gender:M
Credentials:DO PC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2058 S DOBSON RD
Mailing Address - Street 2:#15
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6455
Mailing Address - Country:US
Mailing Address - Phone:480-839-5800
Mailing Address - Fax:480-839-5804
Practice Address - Street 1:2058 S DOBSON RD
Practice Address - Street 2:#15
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6454
Practice Address - Country:US
Practice Address - Phone:480-839-5800
Practice Address - Fax:480-839-5804
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZAZ2996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ26429OtherPROVIDER #