Provider Demographics
NPI:1619157492
Name:PATIL, PRABHUGOUDA B (MD)
Entity Type:Individual
Prefix:DR
First Name:PRABHUGOUDA
Middle Name:B
Last Name:PATIL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:509 W TIDWELL RD STE 160
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-4369
Mailing Address - Country:US
Mailing Address - Phone:713-697-7166
Mailing Address - Fax:713-697-7606
Practice Address - Street 1:509 W TIDWELL RD STE 160
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-4369
Practice Address - Country:US
Practice Address - Phone:713-697-7166
Practice Address - Fax:713-697-7606
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2020-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE4918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8726B6Medicare PIN