Provider Demographics
NPI:1184737959
Name:PATEL, BHUPENDRA P (MD, PA)
Entity type:Individual
Prefix:DR
First Name:BHUPENDRA
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:DR
Other - First Name:BHUPENDRA
Other - Middle Name:P
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:925 N STONE ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2521
Mailing Address - Country:US
Mailing Address - Phone:386-736-9317
Mailing Address - Fax:
Practice Address - Street 1:925 N STONE ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2521
Practice Address - Country:US
Practice Address - Phone:386-734-6007
Practice Address - Fax:386-734-6008
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG11571Medicare UPIN
64440Medicare ID - Type Unspecified