Provider Demographics
NPI:1720213770
Name:PATTON, EDDIE L JR (MD)
Entity type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:L
Last Name:PATTON
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST., STE 2070
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1541
Mailing Address - Country:US
Mailing Address - Phone:713-486-8000
Mailing Address - Fax:713-486-8088
Practice Address - Street 1:929 GESSNER RD, STE 2410
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2584
Practice Address - Country:US
Practice Address - Phone:713-486-7720
Practice Address - Fax:713-486-7744
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN46562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00106WOtherMDCR GRP PTAN NUMBER
TX153449704Medicaid
TXP01089607OtherRR MEDICARE
TX284210601Medicaid
TX1720213770OtherBLUE CROSS BLUE SHIELD
TX284210602Medicaid
TXP01254967OtherMEDICARE RR
TX0035TDOtherBCBSTX GRP PROVIDER RECORD NUMBER