Healthcare Provider Details

I. General information

NPI: 1114983178
Provider Name (Legal Business Name): DAMYANTI S PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201A BRIARCREST DR
BRYAN TX
77802-5223
US

IV. Provider business mailing address

1402 ESSEX GRN
COLLEGE STATION TX
77845-8349
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-9400
  • Fax: 979-774-8903
Mailing address:
  • Phone: 979-696-1231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF6067
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: