Healthcare Provider Details

I. General information

NPI: 1548235419
Provider Name (Legal Business Name): ASHVIN D. PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W MAIN ST
FREDERICKTOWN MO
63645-1111
US

IV. Provider business mailing address

1307 STONEGATE ST
FARMINGTON MO
63640-1070
US

V. Phone/Fax

Practice location:
  • Phone: 573-783-3341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number106711
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number106711
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: