Provider Demographics
NPI:1457333742
Name:PATEL, SAMIR NATWAR (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:NATWAR
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 1:625 W BALDWIN RD
Mailing Address - Street 2:STE C
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3359
Mailing Address - Country:US
Mailing Address - Phone:850-769-0329
Mailing Address - Fax:844-563-8135
Practice Address - Street 1:625 W BALDWIN RD STE C
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3359
Practice Address - Country:US
Practice Address - Phone:850-769-0329
Practice Address - Fax:844-212-7396
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106344207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002304700Medicaid
MS9646138OtherAETNA
MSP00607087OtherRAILROAD
FLDQ106ZOtherMEDICARE
MS05977291Medicaid
MS512I110151Medicare PIN
LA4K528Medicare PIN
LA4K5287061Medicare PIN