Provider Demographics
NPI:1780668426
Name:PAGAN, PATRICIA ANN (MD)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:PAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:PALMOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:108 LIFESTYLE WAY
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307-3914
Mailing Address - Country:US
Mailing Address - Phone:423-338-7777
Mailing Address - Fax:423-338-9326
Practice Address - Street 1:108 LIFESTYLE WAY
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:TN
Practice Address - Zip Code:37307-3914
Practice Address - Country:US
Practice Address - Phone:423-338-7777
Practice Address - Fax:423-338-9326
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35849207Q00000X, 2083P0901X
SD3583207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4041838OtherBCBS
D79860Medicare UPIN
TN3871423Medicare ID - Type Unspecified