Provider Demographics
NPI:1336135102
Name:PATEL, PRASHANT R (MD)
Entity Type:Individual
Prefix:
First Name:PRASHANT
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 SE OSCEOLA ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2301
Mailing Address - Country:US
Mailing Address - Phone:772-223-5955
Mailing Address - Fax:772-223-5954
Practice Address - Street 1:501 SE OSCEOLA ST
Practice Address - Street 2:SUITE 301
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2301
Practice Address - Country:US
Practice Address - Phone:772-223-5955
Practice Address - Fax:772-223-5954
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0064712207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0064712OtherMEDICAL LICENSE
FL253700100Medicaid
44230OtherBCBS
FL3768630001Medicare NSC
FLE0059AMedicare PIN