Provider Demographics
NPI:1003866823
Name:PATEL, SANJAY A (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:A
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 1:419 SW 15TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0609
Mailing Address - Country:US
Mailing Address - Phone:352-732-6400
Mailing Address - Fax:352-671-5283
Practice Address - Street 1:419 SW 15TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0609
Practice Address - Country:US
Practice Address - Phone:352-732-6400
Practice Address - Fax:352-671-5283
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110204280OtherRAILROAD MEDICARE ID
FL379034700Medicaid
FL10D0974350OtherCLIA #
FL593636232OtherTAX ID
FL69007OtherME #
FL69007OtherME #
FLG11717Medicare UPIN