Healthcare Provider Details

I. General information

NPI: 1477641462
Provider Name (Legal Business Name): JAYENDRAKUMAR I PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/07/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 MALCOLM BLVD
CONNELLY SPRINGS NC
28612
US

IV. Provider business mailing address

722 MALCOLM BLVD.
CONNELLY SPRINGS NC
28612
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-7655
  • Fax: 828-874-2278
Mailing address:
  • Phone: 828-580-7655
  • Fax: 828-874-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number23417
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: