Healthcare Provider Details

I. General information

NPI: 1194739342
Provider Name (Legal Business Name): MAHENDRA C PATEL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7711 LOUIS PASTEUR DR STE 502
SAN ANTONIO TX
78229-3415
US

IV. Provider business mailing address

7711 LOUIS PASTEUR DR STE 502
SAN ANTONIO TX
78229-3415
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-9973
  • Fax: 210-614-9969
Mailing address:
  • Phone: 210-614-9973
  • Fax: 210-614-9969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberK1615
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: