Healthcare Provider Details

I. General information

NPI: 1003510249
Provider Name (Legal Business Name): MEGHAN PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 SAXON BLVD
ORANGE CITY FL
32763-8468
US

IV. Provider business mailing address

1100 BELK BLVD
OXFORD MS
38655-5242
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-7560
  • Fax: 386-917-7293
Mailing address:
  • Phone: 662-636-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS23293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: