MEDICARE: JITENDRA C 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD15202	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588668230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JITENDRA C PATEL MD

Provider Business Mailing Address
First Line	:	PO BOX 2742
Second Line	:
City	:	HARBOR
State	:	OR
Zip	:	97415-0326
Country	:	US
Telephone Number	:	541-412-9800
Fax Number	:	541-412-9600

Provider Business Practice Location Address
First Line	:	97825 SHOPPING CENTER AVE
Second Line	:
City	:	BROOKINGS
State	:	OR
Zip	:	97415
Country	:	US
Telephone Number	:	541-412-9800
Fax Number	:	541-412-9600

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	11/08/2007

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