Provider Demographics
NPI:1255406302
Name:PATEL, BHAVNABEN B (MD)
Entity type:Individual
Prefix:
First Name:BHAVNABEN
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BHAVNA
Other - Middle Name:B
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:999 NORTH STONE STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720
Mailing Address - Country:US
Mailing Address - Phone:386-738-6804
Mailing Address - Fax:386-943-4046
Practice Address - Street 1:999 NORTH STONE STREET
Practice Address - Street 2:SUITE A
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720
Practice Address - Country:US
Practice Address - Phone:386-738-6804
Practice Address - Fax:386-943-4046
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48873208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
04164OtherBCBS
FL0456904600Medicaid
04164Medicare ID - Type Unspecified
FL0456904600Medicaid