Provider Demographics
NPI:1659332971
Name:PATEL, JYOTI R (MD)
Entity Type:Individual
Prefix:
First Name:JYOTI
Middle Name:R
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 1:13620 N SAGUARO BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-8551
Mailing Address - Country:US
Mailing Address - Phone:480-816-3131
Mailing Address - Fax:480-816-3136
Practice Address - Street 1:13620 N SAGUARO BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-8551
Practice Address - Country:US
Practice Address - Phone:480-816-3131
Practice Address - Fax:480-816-3136
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31674207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH92390Medicare UPIN
AZ107141Medicare ID - Type Unspecified