Provider Demographics
NPI:1437269750
Name:PATEL, ANITA R (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 BROOK CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8181
Mailing Address - Country:US
Mailing Address - Phone:813-654-5331
Mailing Address - Fax:813-654-5336
Practice Address - Street 1:3427 BROOK CROSSING DRIVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8102
Practice Address - Country:US
Practice Address - Phone:813-654-5331
Practice Address - Fax:813-654-5336
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102540207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000106464Medicare NSC