Individual
JAYESH KISHOR PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1327 TROUP HWY, TYLER, TX 75701-4443
(903) 510-8840
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
R0902
KY
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
N2717
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
215969101
—
TX
01
—
75-2616977-113
TRICARE
TX
01
—
8AM685
BCBS
TX
01
—
TIN PLUS 021
TRICARE
TX
Enumeration date
07/30/2008
Last updated
10/13/2014
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