Basic Information
| Provider Information | |||||||||
| NPI: | 1770745523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATTON | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DOFFING | ||||||||
| OtherFirstName: | KRISTIN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5 MEDICAL PARK DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BENTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720153729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017784862 | ||||||||
| FaxNumber: | 5017784685 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 MEDICAL PARK DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BENTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720153729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017784862 | ||||||||
| FaxNumber: | 5017784685 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2008 | ||||||||
| LastUpdateDate: | 10/03/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | T-2139 | MS | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 036133188 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | E-9576 | AR | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.