Basic Information
| Provider Information | |||||||||
| NPI: | 1356526917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | SAMIR | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98509 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708849509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257692200 | ||||||||
| FaxNumber: | 2257682185 | ||||||||
| Practice Location | |||||||||
| Address1: | 10101 PARK ROWE AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708101685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257692200 | ||||||||
| FaxNumber: | 2257682185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2008 | ||||||||
| LastUpdateDate: | 01/15/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 29506 | AL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | MD.201366 | LA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | MD.201366 | LA | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 01577704 | 05 | MS | MEDICAID | 51598275 | 01 | AL | BCBS | OTHER | 110387 | 05 | AL | MEDICAID | 51598276 | 01 | AL | BCBS | OTHER | 110385 | 05 | AL | MEDICAID | 110388 | 05 | AL | MEDICAID | 51100183 | 01 | AL | BCBS | OTHER | 51598277 | 01 | AL | BCBS | OTHER | P00761079 | 01 | AL | RAILROAD MEDICARE | OTHER | 1090506 | 05 | LA | MEDICAID | 114344 | 05 | AL | MEDICAID |