Provider Demographics
NPI:1083699334
Name:PATEL, JAYPRAKASH D (MD)
Entity Type:Individual
Prefix:
First Name:JAYPRAKASH
Middle Name:D
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:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:JEMISON
Mailing Address - State:AL
Mailing Address - Zip Code:35085
Mailing Address - Country:US
Mailing Address - Phone:205-688-4050
Mailing Address - Fax:205-688-3207
Practice Address - Street 1:24548 US HWY 31
Practice Address - Street 2:
Practice Address - City:JEMISON
Practice Address - State:AL
Practice Address - Zip Code:35085
Practice Address - Country:US
Practice Address - Phone:205-688-4050
Practice Address - Fax:205-688-3207
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F63111Medicare UPIN
000020744Medicare ID - Type Unspecified