Provider Demographics
NPI:1386780484
Name:PARDEN, PATRICK JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOHN
Last Name:PARDEN
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 1:1814 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2540
Mailing Address - Country:US
Mailing Address - Phone:208-667-2531
Mailing Address - Fax:208-765-9385
Practice Address - Street 1:1814 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2540
Practice Address - Country:US
Practice Address - Phone:208-667-2531
Practice Address - Fax:208-765-9385
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4785207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID47852OtherBLUE CROSS OF IDAHO
15180003516OtherNORTH IDAHO CATARACT & LA
ID000010006057OtherREGENCE BLUE SHIELD OF ID
ID003888500Medicaid
ID000010006057OtherREGENCE BLUE SHIELD OF ID
E04217Medicare UPIN
15180003516OtherNORTH IDAHO CATARACT & LA