Provider Demographics
NPI:1225074859
Name:PATEL, MEHMOOD M (MD,)
Entity Type:Individual
Prefix:DR
First Name:MEHMOOD
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:401 SAINT JULIEN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4621
Mailing Address - Country:US
Mailing Address - Phone:337-234-3249
Mailing Address - Fax:337-234-0335
Practice Address - Street 1:401 SAINT JULIEN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4621
Practice Address - Country:US
Practice Address - Phone:337-234-3249
Practice Address - Fax:337-234-0335
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA4002R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1793353Medicaid
LAB89126Medicare UPIN
LA1793353Medicaid