Provider Demographics
NPI:1922367572
Name:PATEL, PALAK JITENDRA (MD)
Entity Type:Individual
Prefix:MR
First Name:PALAK
Middle Name:JITENDRA
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2742
Mailing Address - Street 2:
Mailing Address - City:HARBOR
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0326
Mailing Address - Country:US
Mailing Address - Phone:541-412-9800
Mailing Address - Fax:541-412-9600
Practice Address - Street 1:97825 SHOPPING CENTER AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9403
Practice Address - Country:US
Practice Address - Phone:707-412-9800
Practice Address - Fax:707-412-9600
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA142046207RG0300X
ORMD176416207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine