Provider Demographics
NPI:1356695688
Name:PATEL, PRITESH
Entity type:Individual
Prefix:DR
First Name:PRITESH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 W WHEATLAND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-4410
Mailing Address - Country:US
Mailing Address - Phone:469-313-0040
Mailing Address - Fax:469-313-0041
Practice Address - Street 1:3503 W WHEATLAND RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-4410
Practice Address - Country:US
Practice Address - Phone:469-313-0040
Practice Address - Fax:469-313-0041
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2002207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLUO3087OtherFLORIDA DEPARTMENT OF HEALTH
TXR2002OtherTEXAS MEDICAL BOARD