Provider Demographics
NPI:1194752196
Name:PATEL, VIJESH K (MD)
Entity type:Individual
Prefix:
First Name:VIJESH
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VIJESH
Other - Middle Name:K
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1616207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AW626OtherBCBS INDIVIDUAL
TX113405801Medicaid
TXF96997Medicare UPIN
TX113405801Medicaid