Provider Demographics
NPI:1700061736
Name:PATEL, TEJAS P (MD)
Entity Type:Individual
Prefix:
First Name:TEJAS
Middle Name:P
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 2129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2129
Mailing Address - Country:US
Mailing Address - Phone:432-337-3117
Mailing Address - Fax:432-640-2868
Practice Address - Street 1:720 GOLDER AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4442
Practice Address - Country:US
Practice Address - Phone:432-337-3117
Practice Address - Fax:432-640-2868
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7159207R00000X, 207RC0000X
NMMD214-0864207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09621831Medicaid
TX215408003Medicaid
NM09621831Medicaid
NM393196ZJCFMedicare PIN