=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407851918
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANGEETA PATIL M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2005
-----------------------------------------------------
Last Update Date | 11/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 W AVERY ST
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32501-1907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-437-8650
-----------------------------------------------------
Fax | 850-437-8659
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 W AVERY ST
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32501-1907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-437-8650
-----------------------------------------------------
Fax | 850-437-8659
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 34702
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME 107280
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------