Provider Demographics
NPI:1679549232
Name:PATEL, BHAVESH S (MD)
Entity Type:Individual
Prefix:
First Name:BHAVESH
Middle Name:S
Last Name:PATEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2600 LAKE LUCIEN DR STE 112
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7233
Mailing Address - Country:US
Mailing Address - Phone:321-207-9029
Mailing Address - Fax:844-410-7960
Practice Address - Street 1:4348 SOUTHPOINT BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0986
Practice Address - Country:US
Practice Address - Phone:904-281-1915
Practice Address - Fax:904-281-1119
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2019-11-01
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Provider Licenses
StateLicense IDTaxonomies
FLME84047207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH09506Medicare UPIN