Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | G72662 | CA |
NPI | 1306921580 |
---|---|
Provider Name | Dr. Thomas Stevenson Pattison |
First Address | Davis, CA 95617 |
Second Address | Sacramento, CA 95819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 26/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2610834 | MEDICAL PIN # (01) | CA |
F87615 | (02) | CA |