MEDICARE: PAYAL R PATEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	110392	MO

General Provider Information

NPI Number	:	1659389930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAYAL R PATEL MD

Provider Business Mailing Address
First Line	:	1403 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3115
Country	:	US
Telephone Number	:	314-955-9355
Fax Number	:	314-955-2187

Provider Business Practice Location Address
First Line	:	1403 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3115
Country	:	US
Telephone Number	:	314-955-9355
Fax Number	:	314-955-2187

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	05/22/2024

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