Provider Demographics
NPI:1043296999
Name:PATEL, JASHBHAI K (MD)
Entity Type:Individual
Prefix:
First Name:JASHBHAI
Middle Name:K
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1223 GATEWAY DR
Practice Address - Street 2:SUITE 2B
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-728-6002
Practice Address - Fax:321-676-9731
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42694208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00736798OtherRR MEDICARE NUMBER
FL014492300OtherMEDICAID
FL79902VMedicare PIN
P00736798OtherRR MEDICARE NUMBER
FL79902OtherBLUE CROSS BLUE SHIELD
FL4781161004OtherCIGNA
FL4123662OtherAETNA