Provider Demographics
NPI:1265693311
Name:PATEL, NISHANT JAYANTI (MD)
Entity type:Individual
Prefix:
First Name:NISHANT
Middle Name:JAYANTI
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 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:4370 MEDICAL ARTS DR
Practice Address - Street 2:SUITE 295
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1712
Practice Address - Country:US
Practice Address - Phone:972-691-3777
Practice Address - Fax:972-691-3666
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008016746207R00000X
TXQ2600207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FK385OtherBCBSTX PROVIDER IDENTIFICATION NUMBER
TX8FK385OtherBCBSTX PROVIDER IDENTIFICATION NUMBER