Provider Demographics
NPI:1730184730
Name:PATTON, DEMETRIUS L (MD)
Entity type:Individual
Prefix:MR
First Name:DEMETRIUS
Middle Name:L
Last Name:PATTON
Suffix:
Gender:M
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 347
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:KY
Mailing Address - Zip Code:42078-0347
Mailing Address - Country:US
Mailing Address - Phone:270-988-3298
Mailing Address - Fax:270-988-4642
Practice Address - Street 1:141 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:KY
Practice Address - Zip Code:42078-8043
Practice Address - Country:US
Practice Address - Phone:270-988-3298
Practice Address - Fax:270-988-4642
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047153A174400000X
KYTP792208600000X
KY45974208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100230640Medicaid
IN200352900Medicaid
KYK070661Medicare PIN
IN200352900Medicaid
KY7100230640Medicaid
KYK070663Medicare PIN
KYK070664Medicare PIN
INH60597Medicare UPIN