Healthcare Provider Details

I. General information

NPI: 1013573930
Provider Name (Legal Business Name): DIVYANK PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E MARSHALL AVE
LONGVIEW TX
75601-5545
US

IV. Provider business mailing address

4801 ALBERTA AVE
EL PASO TX
79905-2707
US

V. Phone/Fax

Practice location:
  • Phone: 903-315-4880
  • Fax: 903-315-2833
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberW7890
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: