MEDICARE: MAYUR PATEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	65292	TN
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2084P0301X	Brain Injury Medicine (Psychiatry & Neurology) Physician	65292	TN

General Provider Information

NPI Number	:	1134656903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYUR PATEL

Provider Business Mailing Address
First Line	:	4306 DE ZAVALA RD BLDG 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4590
Country	:	US
Telephone Number	:	210-450-6720
Fax Number	:	210-450-4924

Provider Business Practice Location Address
First Line	:	4306 DE ZAVALA RD BLDG 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4590
Country	:	US
Telephone Number	:	210-450-6720
Fax Number	:	210-450-4924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	03/25/2025

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