Provider Demographics
NPI:1871882449
Name:PATEL, AMAR (MD)
Entity type:Individual
Prefix:
First Name:AMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W GRANDE BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-6124
Mailing Address - Country:US
Mailing Address - Phone:903-597-4644
Mailing Address - Fax:903-592-8500
Practice Address - Street 1:1201 W GRANDE BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6124
Practice Address - Country:US
Practice Address - Phone:903-597-4644
Practice Address - Fax:903-592-8500
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2018-0528207W00000X, 207WX0107X
TXS5043207WX0107X, 207W00000X
LA301831207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX416755301Medicaid
TX8NF669OtherBLUE CROSS BLUE SHIELD