Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 23562 | AZ |
N | 2080A0000X | Adolescent Medicine | 23562 | AZ |
NPI | 1215932850 |
---|---|
Provider Name | Mark Kenneth Patton |
First Address | Phoenix, AZ 85031-1237 |
Second Address | Phoenix, AZ 85031-1237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1369849 | UNITED HEALTHCARE (01) | AZ |
1Z8749 | HEALTHNET (01) | AZ |
339889 | (05) | AZ |
85031A009 | TRICARE (01) | AZ |
AZ0392760 | BCBS (01) | AZ |