Provider Demographics
NPI: | 1437187838 |
---|---|
Name: | PATEL, ANANT NANUBHAI (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ANANT |
Middle Name: | NANUBHAI |
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: | PO BOX 2603 |
Mailing Address - Street 2: | HTN, CLIENT ACCOUNTING |
Mailing Address - City: | FORT WORTH |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76113-2603 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 817-569-4395 |
Mailing Address - Fax: | 817-569-4517 |
Practice Address - Street 1: | 3840 HULEN ST |
Practice Address - Street 2: | HTN, CLIENT ACCOUNTING |
Practice Address - City: | FORT WORTH |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76107-7277 |
Practice Address - Country: | US |
Practice Address - Phone: | 817-569-4395 |
Practice Address - Fax: | 817-569-4517 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-28 |
Last Update Date: | 2011-11-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | M2440 | 2084P0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 184806101 | Medicaid | |
TX | 184806102 | Medicaid | |
TX | 8CS493 | Other | BCBS |
TX | 184806101 | Medicaid | |
TX | 8CS493 | Other | BCBS |
TX | 8G9236 | Medicare PIN |