Basic Information
| Provider Information | |||||||||
| NPI: | 1760645824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | ANIRUDDHA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3945 | ||||||||
| Address2: | DEPT 841 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772533945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813588114 | ||||||||
| FaxNumber: | 2813580609 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 SPENCER HWY | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775041202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133592000 | ||||||||
| FaxNumber: | 7133591004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 01/14/2016 | ||||||||
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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 | 261585 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | P3053 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 306922101 | 05 | TX | MEDICAID | 8DJ489 | 01 | TX | BCBS | OTHER | 306922102 | 05 | TX | MEDICAID | P01151448 | 01 | TX | RAILROAD MEDICARE | OTHER |