Healthcare Provider Details

I. General information

NPI: 1003946542
Provider Name (Legal Business Name): DARSHAN R PHATAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 OLD SPANISH TRAIL HARRIS COUNTY MEDICAL EXAMINER
HOUSTON TX
77054
US

IV. Provider business mailing address

2255 BRAESWOOD PARK DR APARTMENT #221
HOUSTON TX
77030-4454
US

V. Phone/Fax

Practice location:
  • Phone: 713-796-6776
  • Fax:
Mailing address:
  • Phone: 713-796-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number223427
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberM4445
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: