Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 37153 | TX |
N | 204E00000X | Oral & Maxillofacial Surgeon | 021.002766 | IL |
N | 208200000X | Surgeon | 036.141884 | IL |
N | 208600000X | Surgeon | 036.141884 | IL |
Y | 208200000X | Surgeon | T1511 | TX |
Y | 208600000X | Surgeon | T1511 | TX |
NPI | 1306164066 |
---|---|
Provider Name | Dr. Prem Patel |
First Address | Euless, TX 76039-7859 |
Second Address | Arlington, TX 76017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2010 |
Last Update Date | 25/08/2021 |