Healthcare Provider Details

I. General information

NPI: 1154709814
Provider Name (Legal Business Name): BHAVIN MANISH PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CENTRAL DR STE 310
BEDFORD TX
76022-6029
US

IV. Provider business mailing address

PO BOX 35629
DALLAS TX
75235-0629
US

V. Phone/Fax

Practice location:
  • Phone: 817-267-8470
  • Fax: 817-267-0396
Mailing address:
  • Phone: 214-424-2200
  • Fax: 214-231-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number154105
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberU8416
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: