Healthcare Provider Details

I. General information

NPI: 1932479953
Provider Name (Legal Business Name): JAY BABUBHAI PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 E BELL RD STE 111
PHOENIX AZ
85032-2158
US

IV. Provider business mailing address

PO BOX 20610
MESA AZ
85277-0610
US

V. Phone/Fax

Practice location:
  • Phone: 602-675-2585
  • Fax:
Mailing address:
  • Phone: 480-985-1093
  • Fax: 480-296-7647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number47112
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: