Provider Demographics
NPI:1619297686
Name:PATEL, ASHA K (MD)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:K
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 SAINT VINCENTS DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1601
Mailing Address - Country:US
Mailing Address - Phone:205-939-7000
Mailing Address - Fax:850-785-9220
Practice Address - Street 1:504 N MACARTHUR AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3636
Practice Address - Country:US
Practice Address - Phone:850-769-2158
Practice Address - Fax:850-785-9220
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35163207RN0300X, 207R00000X
FLME137929207RN0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME137929OtherDEPARTMENT OF HEALTH