Provider Demographics
NPI:1497739593
Name:PATEL, JAGDISH M (MD)
Entity Type:Individual
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First Name:JAGDISH
Middle Name:M
Last Name:PATEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:17868 US HIGHWAY 18
Mailing Address - Street 2:#358
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1267
Mailing Address - Country:US
Mailing Address - Phone:714-278-9363
Mailing Address - Fax:714-278-9364
Practice Address - Street 1:301 W BASTANCHURY RD
Practice Address - Street 2:#130
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3419
Practice Address - Country:US
Practice Address - Phone:714-278-9363
Practice Address - Fax:714-278-9364
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-08-22
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Provider Licenses
StateLicense IDTaxonomies
CAA327432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21387Medicare PIN
A26913Medicare UPIN