Provider Demographics
NPI:1134474554
Name:PATEL, RAJAN K (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAJAN
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9012 RESEARCH BLVD
Mailing Address - Street 2:C-13
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-7093
Mailing Address - Country:US
Mailing Address - Phone:405-205-5966
Mailing Address - Fax:
Practice Address - Street 1:3930 S JACKSON DR
Practice Address - Street 2:APT 308
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1706
Practice Address - Country:US
Practice Address - Phone:405-205-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012025207213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery