Healthcare Provider Details

I. General information

NPI: 1639478175
Provider Name (Legal Business Name): RAJESH G PATEL MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST
JACKSON MS
39202-2064
US

IV. Provider business mailing address

PO BOX 24023
JACKSON MS
39225-4023
US

V. Phone/Fax

Practice location:
  • Phone: 601-936-6001
  • Fax: 601-936-4389
Mailing address:
  • Phone: 601-936-6001
  • Fax: 601-936-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number13294
License Number StateMS

VIII. Authorized Official

Name: RAJESH G PATEL
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 601-936-6001