Provider Demographics
NPI:1386133759
Name:PATEL, DEVAK (DO, MBA)
Entity type:Individual
Prefix:DR
First Name:DEVAK
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2968 RODEO PARK DR W STE 150
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6383
Mailing Address - Country:US
Mailing Address - Phone:505-982-5014
Mailing Address - Fax:505-982-2687
Practice Address - Street 1:2968 RODEO PARK DR W STE 150
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6383
Practice Address - Country:US
Practice Address - Phone:505-982-5014
Practice Address - Fax:505-982-2687
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A21215207QS0010X, 207Q00000X
NMDO2024-0131207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine