Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 3668 | OK |
NPI | 1053306142 |
---|---|
Provider Name | Dr. Dan Eldon Patterson |
First Address | Stillwater, OK 74074-7602 |
Second Address | Tulsa, OK 74137-2700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
681024 | UNITED CONCORDIA ID # (01) | OK |
T75390 | (02) | OK |