1528032042 NPI number — RUPERT PATEL MD

Table of content: RUPERT PATEL MD (NPI 1528032042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528032042 NPI number — RUPERT PATEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
RUPERT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528032042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 CREEK WAY DR
Provider Second Line Business Mailing Address:
# 231 A
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77478-4072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-999-4360
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 CREEK WAY DR
Provider Second Line Business Practice Location Address:
# 231 A
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77478-4072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-999-4360
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  L5868 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: L5868 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0210X , with the licence number: L5868 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8BX844 . This is a "BCBS INDIVIDUAL NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1736191-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 173619102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 173619105 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 173619107 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 173619108 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 173619109 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 173619106 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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