Provider Demographics
NPI:1528032042
Name:PATEL, RUPERT (MD)
Entity type:Individual
Prefix:
First Name:RUPERT
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 1:1400 CREEK WAY DR
Mailing Address - Street 2:# 231 A
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4072
Mailing Address - Country:US
Mailing Address - Phone:832-999-4360
Mailing Address - Fax:
Practice Address - Street 1:1400 CREEK WAY DR
Practice Address - Street 2:# 231 A
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4072
Practice Address - Country:US
Practice Address - Phone:832-999-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5868207R00000X, 207RN0300X, 2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BX844OtherBCBS INDIVIDUAL NUMBER
TX1736191-01Medicaid
TX173619102Medicaid
TX173619105Medicaid
TX173619107Medicaid
TX173619108Medicaid
TX173619109Medicaid
TX173619106Medicaid
TX173619105Medicaid
TX173619107Medicaid
TX173619108Medicaid
TX173619102Medicaid
TX8F21786Medicare PIN
TX173619109Medicaid