Healthcare Provider Details

I. General information

NPI: 1730743915
Provider Name (Legal Business Name): RUTVI PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 REDSTONE AVE W STE 410
CRESTVIEW FL
32536-6457
US

IV. Provider business mailing address

550 REDSTONE AVE W STE 410
CRESTVIEW FL
32536-6457
US

V. Phone/Fax

Practice location:
  • Phone: 850-306-2188
  • Fax: 850-306-2044
Mailing address:
  • Phone: 850-306-2188
  • Fax: 850-306-2044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number101182
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME179343
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: