Healthcare Provider Details

I. General information

NPI: 1134474554
Provider Name (Legal Business Name): RAJAN K PATEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9012 RESEARCH BLVD STE C13
AUSTIN TX
78758-7012
US

IV. Provider business mailing address

9012 RESEARCH BLVD C-13
AUSTIN TX
78758-7093
US

V. Phone/Fax

Practice location:
  • Phone: 512-450-0101
  • Fax:
Mailing address:
  • Phone: 405-205-5966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2012025207
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: