Provider Demographics
NPI:1811339054
Name:PATEL, SAMIR VITTHALBHAI (MD, MPH)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:VITTHALBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-5136
Mailing Address - Country:US
Mailing Address - Phone:479-709-7260
Mailing Address - Fax:
Practice Address - Street 1:1120 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5136
Practice Address - Country:US
Practice Address - Phone:479-709-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK39696207R00000X, 208M00000X
390200000X
ARE-9994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program