Provider Demographics
NPI:1649231440
Name:PATEL, TUSHAR (MBCHB)
Entity Type:Individual
Prefix:DR
First Name:TUSHAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MBCHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 SAN PABLO RD S
Mailing Address - Street 2:STABILE BLDG N
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1865
Mailing Address - Country:US
Mailing Address - Phone:904-953-2000
Mailing Address - Fax:904-953-1756
Practice Address - Street 1:4500 SAN PABLO RD S
Practice Address - Street 2:STABILE BLDG N
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1865
Practice Address - Country:US
Practice Address - Phone:904-953-2000
Practice Address - Fax:904-953-1756
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089113207RG0100X
FLME108804207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2715299Medicaid
FL277560300Medicaid
OHPA4201251Medicare PIN
OH2715299Medicaid