Provider Demographics
NPI:1750386587
Name:PATEL, JASH I (MD)
Entity type:Individual
Prefix:DR
First Name:JASH
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JASH
Other - Middle Name:I
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1310 GAUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3016
Mailing Address - Country:US
Mailing Address - Phone:985-643-5476
Mailing Address - Fax:985-641-2854
Practice Address - Street 1:1310 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3016
Practice Address - Country:US
Practice Address - Phone:985-643-5476
Practice Address - Fax:985-641-2854
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07995R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1908550Medicaid
2093912OtherECFMG
MS00232796Medicaid
LA392059YH3VMedicare PIN
LA5N284Medicare ID - Type Unspecified
LA1908550Medicaid
2093912OtherECFMG