Healthcare Provider Details

I. General information

NPI: 1528293842
Provider Name (Legal Business Name): PURVAK PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2009
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 BROOK AVE
WICHITA FALLS TX
76301-4289
US

IV. Provider business mailing address

PO BOX 3488 DEPT 05-177
TUPELO MS
38803-3488
US

V. Phone/Fax

Practice location:
  • Phone: 940-766-0217
  • Fax: 940-766-0730
Mailing address:
  • Phone: 479-452-9416
  • Fax: 479-242-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036167638
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberP1578
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE-17042
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD166563
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: