Provider Demographics
NPI:1154366938
Name:VIJESH K. PATEL. M.D., PA
Entity type:Organization
Organization Name:VIJESH K. PATEL. M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VIJESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-729-3787
Mailing Address - Street 1:876 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-3712
Mailing Address - Country:US
Mailing Address - Phone:409-729-3787
Mailing Address - Fax:409-722-8660
Practice Address - Street 1:876 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-3712
Practice Address - Country:US
Practice Address - Phone:409-729-3787
Practice Address - Fax:409-722-8660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1616207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0084RFOtherBCBS GROUP
TX319970501Medicaid
TXF96997Medicare UPIN
TXOA3167Medicare PIN