Provider Demographics
NPI:1134298581
Name:PATEL, PARESHKUMAR M (DO)
Entity Type:Individual
Prefix:
First Name:PARESHKUMAR
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-378-3699
Practice Address - Street 1:3645 WESTERN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1936
Practice Address - Country:US
Practice Address - Phone:817-232-9767
Practice Address - Fax:817-232-9102
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5177207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200198403Medicaid
TX200198401Medicaid
TX8L8013Medicare PIN
TX8L8018Medicare PIN
TX200198402Medicaid
TX8L8015Medicare PIN