Provider Demographics
NPI:1538172168
Name:RAJ PATEL, M.D., P.A.
Entity type:Organization
Organization Name:RAJ PATEL, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAJSHEKHAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-697-0100
Mailing Address - Street 1:PO BOX 5171
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-5171
Mailing Address - Country:US
Mailing Address - Phone:432-697-0100
Mailing Address - Fax:432-694-4447
Practice Address - Street 1:4214 ANDREWS HWY STE 100B
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4872
Practice Address - Country:US
Practice Address - Phone:432-697-0100
Practice Address - Fax:432-694-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134887203Medicaid
TX134887203Medicaid