Healthcare Provider Details

I. General information

NPI: 1609221787
Provider Name (Legal Business Name): RAJ GOPESH PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 SHOAL CREEK BLVD STE 103
AUSTIN TX
78757-8051
US

IV. Provider business mailing address

7951 SHOAL CREEK BLVD STE 300
AUSTIN TX
78757-7582
US

V. Phone/Fax

Practice location:
  • Phone: 512-467-7246
  • Fax: 512-467-7247
Mailing address:
  • Phone: 512-584-8404
  • Fax: 512-467-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-152625
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberT1805
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: