Provider Demographics
NPI:1114173754
Name:PATEL, RAJEEV JAYENDRA (MD)
Entity Type:Individual
Prefix:
First Name:RAJEEV
Middle Name:JAYENDRA
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 SAINT MICHAEL DR
Mailing Address - Street 2:SUITE 345
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2379
Mailing Address - Country:US
Mailing Address - Phone:903-838-5500
Mailing Address - Fax:903-614-6140
Practice Address - Street 1:2604 SAINT MICHAEL DR
Practice Address - Street 2:SUITE 345
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2379
Practice Address - Country:US
Practice Address - Phone:903-838-5500
Practice Address - Fax:903-614-6140
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNUMBER PENDING207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX304382YT5VMedicare PIN