Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 38470 | CO |
NPI | 1003974486 |
---|---|
Provider Name | Dr. John William Patton III |
First Address | Mancos, CO 81328 |
Second Address | Cortez, CO 81321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
84239361 | (05) | CO |