Provider Demographics
NPI:1225189228
Name:PATTERSON, BRUCE WAYNE (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:WAYNE
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 W. ANDERSON LANE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1289
Mailing Address - Country:US
Mailing Address - Phone:512-459-4367
Mailing Address - Fax:512-459-8353
Practice Address - Street 1:2000 W. ANDERSON LANE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1289
Practice Address - Country:US
Practice Address - Phone:512-459-4367
Practice Address - Fax:512-459-8353
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8102208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC20299Medicare UPIN