Provider Demographics
NPI:1932273059
Name:PATEL, SONAL R (MD)
Entity Type:Individual
Prefix:
First Name:SONAL
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 AVERY DR
Mailing Address - Street 2:#3202
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-5397
Mailing Address - Country:US
Mailing Address - Phone:817-657-2328
Mailing Address - Fax:
Practice Address - Street 1:6120 AVERY DR
Practice Address - Street 2:#3202
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-5397
Practice Address - Country:US
Practice Address - Phone:817-657-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188951102Medicaid
TX0020PTOtherBCBS
TX612909Medicare PIN