Provider Demographics
NPI:1871580522
Name:PATTON, BRENDA C (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:C
Last Name:PATTON
Suffix:
Gender:F
Credentials:MD
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 11720
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304
Mailing Address - Country:US
Mailing Address - Phone:928-771-5759
Mailing Address - Fax:929-771-5471
Practice Address - Street 1:1003 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-771-5470
Practice Address - Fax:928-771-5471
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22231207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ323569Medicaid
3235690001OtherAPIPA
FL913113000Medicaid
P00098328OtherRAILROAD MEDICARE
AZAZ0744390OtherBCBS
AZ323569Medicaid
FL913113000Medicaid