Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 2785521205 | UT |
NPI | 1114967163 |
---|---|
Provider Name | Craig P Patten |
First Address | Spanish Fork, UT 84660-0010 |
Second Address | Provo, UT 84604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 06/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107005683103 | SELECT HEALTH (01) | UT |
870492357PA1 | EDUCATORS MUTUAL (01) | UT |
870636000PAT | EDUCATORS MUTUAL (01) | UT |
930085777 | RAILROAD MEDICARE (01) | |
94278552100001 | BCBS (01) | UT |
94278552104001 | BCBS (01) | UT |
94278552105001 | BCBS (01) | UT |
D3067 | (05) | UT |
G65267 | (02) | |
P00395947 | RR MEDICARE (01) |