Provider Demographics
NPI:1518088111
Name:PATEL, JIGNESHKUMAR BABUBHAI (MD)
Entity Type:Individual
Prefix:
First Name:JIGNESHKUMAR
Middle Name:BABUBHAI
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:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1050
Mailing Address - Country:US
Mailing Address - Phone:727-372-4500
Mailing Address - Fax:727-372-3500
Practice Address - Street 1:1818 SHORT BRANCH DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4425
Practice Address - Country:US
Practice Address - Phone:813-425-5826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 110297207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004464300Medicaid
FK191YOtherMEDICARE
FLFK191ZOtherMEDICARE
FLFK191XOtherMEDICARE
FL14H3KOtherBCBS