Healthcare Provider Details

I. General information

NPI: 1659389930
Provider Name (Legal Business Name): PAYAL R PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 HAMPTON AVE
SAINT LOUIS MO
63139-3115
US

IV. Provider business mailing address

1403 HAMPTON AVE
SAINT LOUIS MO
63139-3115
US

V. Phone/Fax

Practice location:
  • Phone: 314-955-9355
  • Fax: 314-955-2187
Mailing address:
  • Phone: 314-955-9355
  • Fax: 314-955-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number110392
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: