Provider Demographics
NPI:1992965982
Name:PATEL, SAMIR PRAVINCHANDRA (DO)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:PRAVINCHANDRA
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 117614
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-7614
Mailing Address - Country:US
Mailing Address - Phone:210-615-1901
Mailing Address - Fax:210-615-1905
Practice Address - Street 1:3903 WISEMAN BLVD
Practice Address - Street 2:STE 311
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4422
Practice Address - Country:US
Practice Address - Phone:210-615-1901
Practice Address - Fax:210-615-1905
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3056207L00000X, 207LP2900X, 208VP0000X
NC2013-01741207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX296904001Medicaid
TX296904002OtherCSHCN
NCNCI338AMedicare PIN
TXTXB152997Medicare PIN