Provider Demographics
NPI:1053722611
Name:DESAI, DIMPLE PATEL (MD)
Entity type:Individual
Prefix:
First Name:DIMPLE PATEL
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 S UTAH AVE
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5588
Mailing Address - Country:US
Mailing Address - Phone:956-854-1306
Mailing Address - Fax:
Practice Address - Street 1:1000 E DOVE AVE STE 200
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3974
Practice Address - Country:US
Practice Address - Phone:956-362-3530
Practice Address - Fax:956-362-3531
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0560207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX367245301Medicaid