Provider Demographics
NPI:1134382328
Name:PATEL, BHARGAVBHAI K (MD)
Entity type:Individual
Prefix:
First Name:BHARGAVBHAI
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BHARGAV
Other - Middle Name:K
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2045
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4542
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2045
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4542
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD153959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR161133OtherNBMC MAIM GROUP MEDCAID
NJ39OtherSTUDENT AND EDUCATION
OR93-0635514OtherNBMC MAIN TAX ID FOR BILLING
OR1407812365OtherNBMC MAIN GROUP NPI
OR500636365Medicaid
ORR0000WFBTVOtherNBMC MAIN GROUP MEDICARE
OR1407812365OtherNBMC MAIN GROUP NPI