Basic Information
| Provider Information | |||||||||
| NPI: | 1790773893 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | DHIRENDRA | ||||||||
| MiddleName: | JASHBHAI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1760 E RIVER RD STE 350 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857185999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205197775 | ||||||||
| FaxNumber: | 5205197910 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 GAIL GARDNER WAY | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863051690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287761040 | ||||||||
| FaxNumber: | 9287761041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 09/16/2019 | ||||||||
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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 | 2085R0001X | 17169 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | AZ0347980 | 01 | AZ | BCBS | OTHER | 920002679 | 01 | AZ | RR MEDICARE | OTHER | 275132 | 05 | AZ | MEDICAID |