Provider Demographics
NPI:1790773893
Name:PATEL, DHIRENDRA JASHBHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:DHIRENDRA
Middle Name:JASHBHAI
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 1:1760 E RIVER RD STE 350
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5999
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:520-519-7910
Practice Address - Street 1:1100 GAIL GARDNER WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1690
Practice Address - Country:US
Practice Address - Phone:928-776-1040
Practice Address - Fax:928-776-1041
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ171692085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0347980OtherBCBS
AZ920002679OtherRR MEDICARE
AZ275132Medicaid
AZ275132Medicaid
WMBPL-01Medicare ID - Type Unspecified