Provider Demographics
NPI:1831284892
Name:MEHTA, PRAFUL R (MD)
Entity Type:Individual
Prefix:MR
First Name:PRAFUL
Middle Name:R
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6100 BANDERA RD
Mailing Address - Street 2:SUITE 710
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1652
Mailing Address - Country:US
Mailing Address - Phone:210-523-9800
Mailing Address - Fax:210-523-9803
Practice Address - Street 1:6100 BANDERA RD
Practice Address - Street 2:SUITE 710
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1652
Practice Address - Country:US
Practice Address - Phone:210-523-9800
Practice Address - Fax:210-523-9803
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF5654207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1367757-03Medicaid
TX110160381OtherMEDICARE RAILROAD
TXD66970Medicare UPIN
TX1367757-03Medicaid