MEDICARE: JAGDISH M PATEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	A32743	CA

General Provider Information

NPI Number	:	1497739593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAGDISH M PATEL MD

Provider Business Mailing Address
First Line	:	17868 US HIGHWAY 18
Second Line	:	#358
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-1267
Country	:	US
Telephone Number	:	714-278-9363
Fax Number	:	714-278-9364

Provider Business Practice Location Address
First Line	:	301 W BASTANCHURY RD
Second Line	:	#130
City	:	FULLERTON
State	:	CA
Zip	:	92835-3419
Country	:	US
Telephone Number	:	714-278-9363
Fax Number	:	714-278-9364

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	08/22/2013

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