Provider Demographics
NPI:1952314775
Name:PATEL, PANKAJ V (MD)
Entity Type:Individual
Prefix:
First Name:PANKAJ
Middle Name:V
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:PO BOX 8749
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79708-8749
Mailing Address - Country:US
Mailing Address - Phone:432-522-1234
Mailing Address - Fax:432-522-2950
Practice Address - Street 1:3403 ANDREWS HWY STE 300
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5132
Practice Address - Country:US
Practice Address - Phone:432-522-1234
Practice Address - Fax:432-522-2950
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4962207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138754006Medicaid
TX138754013Medicaid
TX8322K0Medicare ID - Type Unspecified