Provider Demographics
NPI:1255542262
Name:PATEL, VISHAL CHANDUBHAI (MD)
Entity type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:CHANDUBHAI
Last Name:PATEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2220 COUNTY ROAD 210 WEST
Mailing Address - Street 2:STE 108, PMB 257
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4060
Mailing Address - Country:US
Mailing Address - Phone:904-687-1055
Mailing Address - Fax:904-687-2141
Practice Address - Street 1:8833 PERIMETER PARK BLVD
Practice Address - Street 2:STE 503
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1110
Practice Address - Country:US
Practice Address - Phone:904-687-1055
Practice Address - Fax:904-687-2141
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2023-07-10
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Provider Licenses
StateLicense IDTaxonomies
AL29685207R00000X
FLME121788207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108669600Medicaid
FL12314503OtherCAQH