Provider Demographics
NPI:1114989910
Name:PATEL, DEEPAK C (MD)
Entity Type:Individual
Prefix:
First Name:DEEPAK
Middle Name:C
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 1:400 HOSPITAL DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2489
Mailing Address - Country:US
Mailing Address - Phone:903-641-4895
Mailing Address - Fax:903-641-4894
Practice Address - Street 1:400 HOSPITAL DR
Practice Address - Street 2:STE. 101
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2489
Practice Address - Country:US
Practice Address - Phone:903-641-3800
Practice Address - Fax:903-641-3812
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104134502Medicaid
TX84071XOtherBLUE CROSS
TXG80069Medicare UPIN
TX84071XOtherBLUE CROSS
TX104134502Medicaid