Provider Demographics
NPI:1801828553
Name:PATEL, JYOTI (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTI
Middle Name:
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 1:105 SOUTHPARK BLVD
Mailing Address - Street 2:STE C300
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4162
Mailing Address - Country:US
Mailing Address - Phone:904-808-7246
Mailing Address - Fax:904-808-7090
Practice Address - Street 1:105 SOUTHPARK BLVD
Practice Address - Street 2:STE C-300
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4162
Practice Address - Country:US
Practice Address - Phone:904-808-7246
Practice Address - Fax:904-808-7090
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61180207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15162OtherBLUE CROSS PROVIDER NUMBE
FL34189OtherMEDICARE GRP NUMBER
FL05336700OtherAETNA PROV NUMBER
FL370492100Medicaid
FL05336700OtherAETNA PROV NUMBER
FL34189OtherMEDICARE GRP NUMBER