Provider Demographics
NPI:1902951486
Name:CODE, PATRICK THEODORE (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:THEODORE
Last Name:CODE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 SISKIYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8125
Mailing Address - Country:US
Mailing Address - Phone:541-773-3338
Mailing Address - Fax:541-772-9526
Practice Address - Street 1:2655 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8125
Practice Address - Country:US
Practice Address - Phone:541-773-3338
Practice Address - Fax:541-772-9526
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP002200213E00000X, 213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Not Answered213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR034947Medicaid
OR034947Medicaid
ORU18668Medicare UPIN