Provider Demographics
NPI:1427026822
Name:PATEL, JIGISH M (MD)
Entity Type:Individual
Prefix:
First Name:JIGISH
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 1:3228 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7423
Mailing Address - Country:US
Mailing Address - Phone:850-628-2113
Mailing Address - Fax:850-784-2614
Practice Address - Street 1:3228 E 15TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7423
Practice Address - Country:US
Practice Address - Phone:850-628-2113
Practice Address - Fax:850-784-2614
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253718400Medicaid
FL42876Medicare PIN
FLG70268Medicare UPIN