Provider Demographics
NPI:1205220654
Name:PATEL, PRIYAL (MD)
Entity type:Individual
Prefix:
First Name:PRIYAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SAINT MICHAEL DR STE 401
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5211
Mailing Address - Country:US
Mailing Address - Phone:903-614-5392
Mailing Address - Fax:903-614-5343
Practice Address - Street 1:910 JAMES BOWIE DR
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-2335
Practice Address - Country:US
Practice Address - Phone:903-614-5950
Practice Address - Fax:903-614-5965
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-10866207P00000X
390200000X
TXR8962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200834030AMedicaid
TX3903395Medicaid
TXP02599458OtherRR MCR