Provider Demographics
NPI:1619371465
Name:PATEL, SWAPNILKUMAR P (DPM)
Entity Type:Individual
Prefix:DR
First Name:SWAPNILKUMAR
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 UNIVERSITY BLVD S
Mailing Address - Street 2:BLDG C
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4250
Mailing Address - Country:US
Mailing Address - Phone:904-731-1711
Mailing Address - Fax:904-731-9270
Practice Address - Street 1:3636 UNIVERSITY BLVD S
Practice Address - Street 2:BLDG C
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4250
Practice Address - Country:US
Practice Address - Phone:904-731-1711
Practice Address - Fax:904-731-9270
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001268213ES0103X
FLPO3843213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0C97HOtherBCBS
FLIR297ZMedicare PIN