Provider Demographics
NPI:1871512285
Name:PATEL, SANJAY B (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:B
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 S MAIN ST STE 106
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7509
Mailing Address - Country:US
Mailing Address - Phone:817-421-1517
Mailing Address - Fax:817-416-4659
Practice Address - Street 1:1280 S MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7509
Practice Address - Country:US
Practice Address - Phone:817-421-1517
Practice Address - Fax:817-416-4659
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL2536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166334602Medicaid
TX166334601Medicaid
TX8B8985Medicare ID - Type Unspecified
TXH45096Medicare UPIN
TX166334602Medicaid