Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 1998 | TX |
NPI | 1083912323 |
---|---|
Provider Name | Dr. Dallas Justin Patterson |
First Address | San Antonio, TX 78209-2060 |
Second Address | San Antonio, TX 78209-2060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2011 |
Last Update Date | 03/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TXB158275 | (02) | TX |