Provider Demographics
NPI:1124383203
Name:RAJNI PATEL MD PA
Entity Type:Organization
Organization Name:RAJNI PATEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJNIKANT
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-747-0168
Mailing Address - Street 1:11 W 23RD ST
Mailing Address - Street 2:SUITE B1
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7603
Mailing Address - Country:US
Mailing Address - Phone:850-747-0168
Mailing Address - Fax:859-896-5566
Practice Address - Street 1:11 W 23RD ST
Practice Address - Street 2:SUITE B1
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7603
Practice Address - Country:US
Practice Address - Phone:850-747-0168
Practice Address - Fax:859-896-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00600912084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12679Medicare UPIN