Basic Information
| Provider Information | |||||||||
| NPI: | 1467461426 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | SANTOSH | ||||||||
| MiddleName: | CHANDRAKANT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 730990 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753730990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727911224 | ||||||||
| FaxNumber: | 9726927965 | ||||||||
| Practice Location | |||||||||
| Address1: | 2625 BOLTON BOONE DR | ||||||||
| Address2: | |||||||||
| City: | DESOTO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751152011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722831516 | ||||||||
| FaxNumber: | 9722831448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 08/02/2010 | ||||||||
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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 | 207W00000X | M3352 | TX | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 1877979 01 | 05 | TX | MEDICAID | 8BE521 | 01 | TX | BCBS | OTHER | 8B7172 | 01 | TX | BCBS | OTHER |