Healthcare Provider Details

I. General information

NPI: 1821244286
Provider Name (Legal Business Name): SANJAY H PATEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 SECOR ST GUPTA AND GUPTA PEDIATRICS MD PA
MIDLAND TX
79701-6343
US

IV. Provider business mailing address

4001 FAUDREE RD TUSCANY APT F-301
ODESSA TX
79765-8620
US

V. Phone/Fax

Practice location:
  • Phone: 432-685-5029
  • Fax:
Mailing address:
  • Phone: 347-987-0733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP0468
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: