Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 149 | SD |
Y | 103T00000X | Psychologist | 149 | SD |
NPI | 1003991936 |
---|---|
Provider Name | Mr. Robert G Patterson |
First Address | Aberdeen, SD 57401 |
Second Address | Aberdeen, SD 57401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6550013 | (05) | SD |