Healthcare Provider Details

I. General information

NPI: 1477338713
Provider Name (Legal Business Name): PDH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W SOUTHLAKE BLVD, STE 300
SOUTHLAKE TX
76092
US

IV. Provider business mailing address

221 W SOUTHLAKE BLVD, STE 300
SOUTHLAKE TX
76092
US

V. Phone/Fax

Practice location:
  • Phone: 817-796-8073
  • Fax: 817-796-8360
Mailing address:
  • Phone: 817-796-8073
  • Fax: 817-796-8360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PURAV PATEL
Title or Position: INTERNIST
Credential: M.D.
Phone: 205-382-0890