Provider Demographics
NPI:1528029121
Name:PATTERSON, BRYAN T (DPM)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:T
Last Name:PATTERSON
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 1:1345 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-3962
Mailing Address - Country:US
Mailing Address - Phone:830-372-0190
Mailing Address - Fax:830-372-0191
Practice Address - Street 1:1345 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-3962
Practice Address - Country:US
Practice Address - Phone:830-372-0190
Practice Address - Fax:830-372-0191
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX695213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018777501Medicaid
TXT15194Medicare UPIN
TX018777501Medicaid