Provider Demographics
NPI:1871579706
Name:PATTERSON, JAMES L (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-0370
Mailing Address - Country:US
Mailing Address - Phone:660-200-7000
Mailing Address - Fax:660-200-7004
Practice Address - Street 1:617 W NURSERY ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-1840
Practice Address - Country:US
Practice Address - Phone:660-200-7133
Practice Address - Fax:660-200-2396
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007000367207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204590707Medicaid
CO89985524Medicaid
CO89985524Medicaid
COI10802Medicare UPIN
X43F124Medicare Oscar/Certification
E75F124Medicare Oscar/Certification