Healthcare Provider Details

I. General information

NPI: 1245025774
Provider Name (Legal Business Name): ANSH PATEL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 KINGSLEY AVENUE
ORANGE PARK FL
32073
US

IV. Provider business mailing address

128 ROYAL VALLEY DRIVE
CALEDON ONTARIO
L7C 1A6
CA

V. Phone/Fax

Practice location:
  • Phone: 904-639-2000
  • Fax: 904-639-2015
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: