Provider Demographics
NPI:1477827087
Name:RANA, DIPESH RAMESH (PAC)
Entity Type:Individual
Prefix:
First Name:DIPESH
Middle Name:RAMESH
Last Name:RANA
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 GLEN VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-5511
Mailing Address - Country:US
Mailing Address - Phone:972-693-7467
Mailing Address - Fax:
Practice Address - Street 1:5025 GLEN VISTA DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-5511
Practice Address - Country:US
Practice Address - Phone:972-693-7467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05772363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05772OtherLICENSE #