Provider Demographics
NPI:1720268824
Name:MINESH PATEL MD PA
Entity Type:Organization
Organization Name:MINESH PATEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-833-3535
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1457369983OtherNPI
TX00979TMedicare Oscar/Certification
TX1457369983OtherNPI
TXX77906Medicare PIN