Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | N3236 | TX |
Y | 2080P0210X | Pediatric Nephrologist | N3236 | TX |
NPI | 1104146117 |
---|---|
Provider Name | Dr. Ketan N Patel |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 15/04/2021 |