Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4-18220 | KS |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 4-18220 | KS |
NPI | 1255410635 |
---|---|
Provider Name | James Michael Patton |
First Address | Wichita, KS 67211-3900 |
Second Address | Wichita, KS 67211-3900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2006 |
Last Update Date | 06/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100147780B | (05) | KS |
B69064 | (02) |