Provider Demographics
NPI:1710961883
Name:PATEL, PANKAJ C (MD)
Entity Type:Individual
Prefix:
First Name:PANKAJ
Middle Name:C
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:802 HOPKINS ST
Practice Address - Street 2:GARLAND HEALTH CENTER
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-7379
Practice Address - Country:US
Practice Address - Phone:214-266-0700
Practice Address - Fax:214-266-0656
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149921203Medicaid
TX149921209Medicaid
TX149921213Medicaid
TX149921215Medicaid
TX8W8721OtherBLUE CROSS BLUE SHIELD
TX149921204Medicaid
TX149921206Medicaid
TX149921201Medicaid
TX149921211Medicaid
TX149921214Medicaid
TX149921212Medicaid
TX149921208Medicaid
TX149921205Medicaid
TX149921202Medicaid
TX149921209Medicaid
TX149921211Medicaid