Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | S0969 | TX |
N | 207QS0010X | Family Doctor - Sports Medicine | S0969 | TX |
NPI | 1255726865 |
---|---|
Provider Name | Dr. Niraj Patel |
First Address | San Francisco, CA 94107-1459 |
Second Address | Fort Worth, TX 76107-2553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2015 |
Last Update Date | 02/10/2021 |