Healthcare Provider Details

I. General information

NPI: 1780603050
Provider Name (Legal Business Name): MAHENDRA J PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S COULTER ST
AMARILLO TX
79106-1770
US

IV. Provider business mailing address

PO BOX 8337
AMARILLO TX
79114-8337
US

V. Phone/Fax

Practice location:
  • Phone: 806-354-1260
  • Fax:
Mailing address:
  • Phone: 806-355-6593
  • Fax: 806-352-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE2312
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: