Provider Demographics
NPI:1881663151
Name:PATEL, VIBHA VINOD (DO)
Entity Type:Individual
Prefix:
First Name:VIBHA
Middle Name:VINOD
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4873 VAN ZANDT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6136
Mailing Address - Country:US
Mailing Address - Phone:817-371-7591
Mailing Address - Fax:
Practice Address - Street 1:6363 N STATE HIGHWAY STE 101
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2269
Practice Address - Country:US
Practice Address - Phone:469-200-3272
Practice Address - Fax:888-262-9984
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101827705Medicaid
TX8X1230OtherBLUE CROSS BLUE SHIELD
TX101827709Medicaid
TX87525GOtherBCBS
TX101827706Medicaid
TX10182709Medicaid
TX8W0342OtherBLUE CROSS BLUE SHIELD
TX101827706Medicaid
TX8J2653Medicare PIN
TX87525GOtherBCBS
TX8W0342OtherBLUE CROSS BLUE SHIELD