Provider Demographics
NPI:1407897481
Name:PATEL, JAGDISH A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGDISH
Middle Name:A
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 1:644 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3437
Mailing Address - Country:US
Mailing Address - Phone:209-832-8984
Mailing Address - Fax:209-832-8988
Practice Address - Street 1:644 W 12TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3437
Practice Address - Country:US
Practice Address - Phone:209-832-8984
Practice Address - Fax:209-832-8988
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31816207QA0505X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA31816OtherLICENSE NUMBER
CAA31816OtherLICENSE NUMBER