=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972516516
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PANKAJ V. PATEL, M.D.,P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 W 5TH ST STE 310
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79761-5062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-580-3775
-----------------------------------------------------
Fax | 432-580-8310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8729
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79708-8729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-580-3775
-----------------------------------------------------
Fax | 432-580-8310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | PANKAJ V PATEL
-----------------------------------------------------
Credential | M.D., F.A.C.C.
-----------------------------------------------------
Telephone | 432-580-3775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------