Healthcare Provider Details

I. General information

NPI: 1679549232
Provider Name (Legal Business Name): BHAVESH S PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4348 SOUTHPOINT BLVD SUITE 100
JACKSONVILLE FL
32216-0986
US

IV. Provider business mailing address

2600 LAKE LUCIEN DR STE 112
MAITLAND FL
32751-7233
US

V. Phone/Fax

Practice location:
  • Phone: 904-281-1915
  • Fax: 904-281-1119
Mailing address:
  • Phone: 321-207-9029
  • Fax: 844-410-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME84047
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: