Provider Demographics
NPI:1134133358
Name:PATEL, RAVI R (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11945 SAN JOSE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-396-4893
Practice Address - Street 1:714 STOCKTON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3402
Practice Address - Country:US
Practice Address - Phone:904-355-2121
Practice Address - Fax:904-355-2123
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93231207W00000X, 207W00000X
NY2465611207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48234OtherBCBS INDIVIDUAL
FL000334200Medicaid
FLP00767507OtherRAILROAD MEDICARE
FL7419874OtherAETNA PIN PPO
FL000334200Medicaid
FL000334200Medicaid