Provider Demographics
NPI:1487659850
Name:PATEL, MANUBHAI S (MD)
Entity Type:Individual
Prefix:
First Name:MANUBHAI
Middle Name:S
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1227 N STATE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2002
Mailing Address - Country:US
Mailing Address - Phone:601-355-2485
Mailing Address - Fax:601-353-1463
Practice Address - Street 1:2969 CURRAN DR N
Practice Address - Street 2:STE 200
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4121
Practice Address - Country:US
Practice Address - Phone:601-974-5600
Practice Address - Fax:601-974-5699
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2022-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS14074207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118200Medicaid
5275585OtherAETNA HEALTHCARE
LA1557749Medicaid
MS00118200Medicaid
5275585OtherAETNA HEALTHCARE