Provider Demographics
NPI:1023136322
Name:PATEL, JIGNESH (MD)
Entity type:Individual
Prefix:DR
First Name:JIGNESH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 N 16TH ST APT 1686
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5158
Mailing Address - Country:US
Mailing Address - Phone:216-577-5401
Mailing Address - Fax:
Practice Address - Street 1:4626 N 16TH ST APT 1686
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5158
Practice Address - Country:US
Practice Address - Phone:216-577-5401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2479512085R0202X
NJ25MA086018002085R0202X
AZ477632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN4652OtherTEXAS MEDICAL LICENSE
AZ47763OtherARIZONA MEDICAL BOARD
NY247951OtherNY MEDICAL BOARD
NJ25MA08601800OtherLICENSE