Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 11359 | WV |
Y | 207QS0010X | Family Doctor - Sports Medicine | 11359 | WV |
NPI | 1144282922 |
---|---|
Provider Name | Ross M Patton |
First Address | Huntington, WV 25701-3656 |
Second Address | Huntington, WV 25701-3656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 24/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0048796000 | (05) | WV |
0393962 | (05) | OH |
64696933 | (05) | KY |
A72179 | (02) | WV |