Healthcare Provider Details

I. General information

NPI: 1265643852
Provider Name (Legal Business Name): ANITA DHIRUBHAI PATEL D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 E TRINITY MILLS RD STE 173
CARROLLTON TX
75006-1446
US

IV. Provider business mailing address

PO BOX 746079
ATLANTA GA
30374-6079
US

V. Phone/Fax

Practice location:
  • Phone: 972-962-1296
  • Fax: 469-340-4129
Mailing address:
  • Phone: 127-339-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3916
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM8238
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3916
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: