Provider Demographics
NPI:1760666010
Name:J. M. PATIL, M. D., P. A.
Entity Type:Organization
Organization Name:J. M. PATIL, M. D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAIRAJ
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-385-9497
Mailing Address - Street 1:PO BOX 2246
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-2246
Mailing Address - Country:US
Mailing Address - Phone:409-385-9497
Mailing Address - Fax:409-385-9464
Practice Address - Street 1:603 HIGHWAY 418 W
Practice Address - Street 2:STE #1
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-3660
Practice Address - Country:US
Practice Address - Phone:409-385-9497
Practice Address - Fax:409-385-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126478004Medicaid
TX00Z422Medicare PIN