Healthcare Provider Details

I. General information

NPI: 1053842559
Provider Name (Legal Business Name): NIRAV C PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 SAXON BLVD
ORANGE CITY FL
32763-8468
US

IV. Provider business mailing address

PO BOX 100374
GAINESVILLE FL
32610-0374
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-5526
  • Fax: 386-917-5553
Mailing address:
  • Phone: 352-265-0438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME143527
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: