Provider Demographics
NPI:1588425656
Name:PATTERSON, GARY L JR
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:L
Last Name:PATTERSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 WRENFORD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3156
Mailing Address - Country:US
Mailing Address - Phone:330-328-7716
Mailing Address - Fax:
Practice Address - Street 1:1995 WRENFORD RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3156
Practice Address - Country:US
Practice Address - Phone:330-328-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty