Healthcare Provider Details

I. General information

NPI: 1932262433
Provider Name (Legal Business Name): SUKETU PATEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 WILLIAMS DR SUITE 177
GEORGETOWN TX
78628-2764
US

IV. Provider business mailing address

3010 WILLIAMS DR STE 177
GEORGETOWN TX
78628-2785
US

V. Phone/Fax

Practice location:
  • Phone: 512-868-3376
  • Fax: 512-869-5868
Mailing address:
  • Phone: 512-868-3376
  • Fax: 512-869-5868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number229989
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberN7325
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberH0092858
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: