Provider Demographics
NPI:1205887577
Name:PATEL, JAYNISH (MD)
Entity type:Individual
Prefix:
First Name:JAYNISH
Middle Name:
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:4450 SOJOURN DR STE 200
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5000
Practice Address - Country:US
Practice Address - Phone:972-733-0014
Practice Address - Fax:972-733-0125
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL14242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141207402Medicaid
TX141207404Medicaid
TX141207412Medicaid
TX300132099Medicare PIN
TX141207402Medicaid
TXP00302859Medicare PIN
TX8L26497Medicare PIN
TX8L26671Medicare PIN