Healthcare Provider Details

I. General information

NPI: 1831340231
Provider Name (Legal Business Name): RAZA ALI PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 07/27/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

IV. Provider business mailing address

81 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-3599
  • Fax:
Mailing address:
  • Phone: 801-213-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number248596
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number7849311-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: