Provider Demographics
NPI:1801216072
Name:PATEL, HERSHEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:HERSHEL
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 AVENUE K SW STE 200
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3919
Mailing Address - Country:US
Mailing Address - Phone:863-297-5400
Mailing Address - Fax:833-989-0315
Practice Address - Street 1:250 AVENUE K SW STE 200
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3919
Practice Address - Country:US
Practice Address - Phone:863-297-5400
Practice Address - Fax:833-989-0315
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2020-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME145015207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106409100Medicaid