Provider Demographics
NPI:1467434191
Name:PATEL, JAYENDRA K (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYENDRA
Middle Name:K
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 1:333 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:STE. 220
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5887
Mailing Address - Country:US
Mailing Address - Phone:337-478-9331
Mailing Address - Fax:337-478-9828
Practice Address - Street 1:333 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:STE. 220
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5887
Practice Address - Country:US
Practice Address - Phone:337-478-9331
Practice Address - Fax:337-478-9828
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA735872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2109553Medicaid
LAF97307Medicare UPIN
LA5AD71Medicare PIN