Provider Demographics
NPI:1487117271
Name:PATEL, ROSHAN (MD)
Entity type:Individual
Prefix:
First Name:ROSHAN
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N LOOP 340
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-2400
Mailing Address - Country:US
Mailing Address - Phone:254-870-6500
Mailing Address - Fax:
Practice Address - Street 1:1130 N LOOP 340
Practice Address - Street 2:
Practice Address - City:LACY LAKEVIEW
Practice Address - State:TX
Practice Address - Zip Code:76705-2400
Practice Address - Country:US
Practice Address - Phone:254-870-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301506577207Q00000X
TXT9316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine