Healthcare Provider Details

I. General information

NPI: 1013965128
Provider Name (Legal Business Name): ASHOK R PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E ABRIENDO AVE STE D
PUEBLO CO
81004-2377
US

IV. Provider business mailing address

540 E ABRIENDO AVE STE D
PUEBLO CO
81004-2377
US

V. Phone/Fax

Practice location:
  • Phone: 719-542-7222
  • Fax:
Mailing address:
  • Phone: 719-542-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number223371
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number27185
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: