Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 19396 | AL |
NPI | 1083645378 |
---|---|
Provider Name | Mark A Patterson |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 20/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009922265 | (05) | AL |
009922275 | (05) | AL |
051516170 | BLUE CROSS (01) | AL |
051516172 | BLUE CROSS (01) | AL |