Provider Demographics
NPI:1255353652
Name:PATEL, BHARAT (MD)
Entity type:Individual
Prefix:
First Name:BHARAT
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4226
Mailing Address - Country:US
Mailing Address - Phone:601-649-3821
Mailing Address - Fax:601-649-3827
Practice Address - Street 1:212 S 13TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4226
Practice Address - Country:US
Practice Address - Phone:601-649-3821
Practice Address - Fax:601-649-3827
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115809Medicaid
MS00115809Medicaid