Provider Demographics
NPI:1306921580
Name:PATTISON, THOMAS STEVENSON (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STEVENSON
Last Name:PATTISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1079
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617
Mailing Address - Country:US
Mailing Address - Phone:916-456-2220
Mailing Address - Fax:916-456-2223
Practice Address - Street 1:260 RUSSELL BLVD.
Practice Address - Street 2:SUITE D-4
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616
Practice Address - Country:US
Practice Address - Phone:916-456-2220
Practice Address - Fax:916-456-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72662208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2610834OtherMEDICAL PIN #
CA68-0435381OtherTAX ID#
CA2610834OtherMEDICAL PIN #