Provider Demographics
NPI:1366436412
Name:PATEL, BHUPENDRA C (MD, FRCS)
Entity type:Individual
Prefix:DR
First Name:BHUPENDRA
Middle Name:C
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD, FRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 N MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-1000
Mailing Address - Country:US
Mailing Address - Phone:801-585-6641
Mailing Address - Fax:
Practice Address - Street 1:65 NORTH MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132
Practice Address - Country:US
Practice Address - Phone:801-581-2352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT188029-1205174400000X, 207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT180037474OtherRAILROAD MEDICARE
UT199292OtherIHC NUMBER
TN63914081705001OtherBCBS UTAH NUMBER
NV002084856Medicaid