Provider Demographics
NPI:1992885966
Name:PATEL, TINABEN H (PA)
Entity type:Individual
Prefix:
First Name:TINABEN
Middle Name:H
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:21105 EVA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-1706
Mailing Address - Country:US
Mailing Address - Phone:936-597-8585
Mailing Address - Fax:936-597-6433
Practice Address - Street 1:21105 EVA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-1706
Practice Address - Country:US
Practice Address - Phone:936-597-8585
Practice Address - Fax:936-597-6433
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2017-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA10513363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8536MCOtherBCBS
TX8536MCOtherBCBS