Provider Demographics
NPI:1902880859
Name:PATEL, ANIL C (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:C
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363
Mailing Address - Country:US
Mailing Address - Phone:361-592-0223
Mailing Address - Fax:361-592-0883
Practice Address - Street 1:1018 S 14TH ST
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363
Practice Address - Country:US
Practice Address - Phone:361-592-0223
Practice Address - Fax:361-592-0883
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3383208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018430101Medicaid
TX092544801Medicaid