Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | J3872 | TX |
NPI | 1134154545 |
---|---|
Provider Name | Dr. Chandrakant G Patel |
First Address | Nederland, TX 77627-7842 |
Second Address | Nederland, TX 77627-7842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 03/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0042QU | BLUE CROSS BLUE SHIELD OF TEXAS (01) | TX |
115272001 | (05) | TX |
4501009353 | CLIA (01) | TX |
8AU520 | BLUE CROSS BLUE SHIELD OF TEXAS (01) | TX |
F09772 | (02) |