Healthcare Provider Details

I. General information

NPI: 1316338957
Provider Name (Legal Business Name): DEEP BHARATBHAI PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5238 NORWOOD AVE STE 16
JACKSONVILLE FL
32208-5005
US

IV. Provider business mailing address

8900 VAN WYCK EXPY JAMAICA HOSPITAL MEDICAL CENTER
JAMAICA NY
11418-2832
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-4822
  • Fax: 904-240-4468
Mailing address:
  • Phone: 718-206-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2017038284
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017038284
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 121305
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME121305
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: