Basic Information
| Provider Information | |||||||||
| NPI: | 1174515431 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATTERSON | ||||||||
| FirstName: | EMMA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 NE 20TH AVE STE 340 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972322275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032275050 | ||||||||
| FaxNumber: | 5032272462 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 NE 20TH AVE STE 340 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972322275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032275050 | ||||||||
| FaxNumber: | 5032272462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD22571 | OR | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8322836 | 05 | WA | MEDICAID | 288425 | 05 | OR | MEDICAID | 1111517 | 05 | WA | MEDICAID |