Provider Demographics
NPI:1457360083
Name:PATEL, MINESH M (MD, PA)
Entity Type:Individual
Prefix:
First Name:MINESH
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3091 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4607
Mailing Address - Country:US
Mailing Address - Phone:409-833-3535
Mailing Address - Fax:409-833-4640
Practice Address - Street 1:3091 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4607
Practice Address - Country:US
Practice Address - Phone:409-833-3535
Practice Address - Fax:409-833-4640
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154234201Medicaid
TX00979TMedicare ID - Type Unspecified
TX154234201Medicaid