Provider Demographics
NPI:1316359565
Name:PATEL, JAY (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1605 MARTIN SPRINGS DR STE 330
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2980
Mailing Address - Country:US
Mailing Address - Phone:417-533-6560
Mailing Address - Fax:
Practice Address - Street 1:1605 MARTIN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2982
Practice Address - Country:US
Practice Address - Phone:417-533-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2021028383207X00000X
MN66885207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1316359565Medicaid