Provider Demographics
NPI:1174515431
Name:PATTERSON, EMMA JEAN (MD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:JEAN
Last Name:PATTERSON
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 1:825 NE 20TH AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2275
Mailing Address - Country:US
Mailing Address - Phone:503-227-5050
Mailing Address - Fax:503-227-2462
Practice Address - Street 1:825 NE 20TH AVE STE 340
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2275
Practice Address - Country:US
Practice Address - Phone:503-227-5050
Practice Address - Fax:503-227-2462
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22571208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8322836Medicaid
OR288425Medicaid
WA1111517Medicaid
WA8322836Medicaid
WA1111517Medicaid