Provider Demographics
NPI:1730256116
Name:PATTERSON, BRIAN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LEE
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1925 DON WICKHAM DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1915
Mailing Address - Country:US
Mailing Address - Phone:352-404-8956
Mailing Address - Fax:352-404-8958
Practice Address - Street 1:1925 DON WICKHAM DRIVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-243-9700
Practice Address - Fax:352-243-9844
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 91687207Q00000X
FLME91687208100000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH91174Medicare UPIN