Provider Demographics
NPI:1235115858
Name:PATEL, RAJESH M (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:M
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 1:2332 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4610
Mailing Address - Country:US
Mailing Address - Phone:904-388-2540
Mailing Address - Fax:904-387-6800
Practice Address - Street 1:2332 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4610
Practice Address - Country:US
Practice Address - Phone:904-388-2540
Practice Address - Fax:904-387-6800
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA067805800Medicaid
FL45032Medicare ID - Type Unspecified
FLD40827Medicare UPIN