Provider Demographics
NPI:1235209222
Name:PATEL, LAXMAN P (MD)
Entity Type:Individual
Prefix:
First Name:LAXMAN
Middle Name:P
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 1:444 N 44TH ST
Mailing Address - Street 2:#400
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7624
Mailing Address - Country:US
Mailing Address - Phone:602-685-3846
Mailing Address - Fax:602-685-3808
Practice Address - Street 1:444 N 44TH ST
Practice Address - Street 2:#400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-7624
Practice Address - Country:US
Practice Address - Phone:602-685-3846
Practice Address - Fax:602-685-3808
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ161612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ259748Medicaid
AZ103367Medicare ID - Type Unspecified
AZD44349Medicare UPIN