Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD08076 | RI |
NPI | 1124101258 |
---|---|
Provider Name | Dr. Robert B Patterson |
First Address | Providence, RI 02904-1556 |
Second Address | Providence, RI 02904-1556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 28/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20902 | BCBS (01) | RI |
9006659 | (05) | RI |
A16449 | (02) |