Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN 19054 | FL |
NPI | 1003127960 |
---|---|
Provider Name | Dr. Remal Patel |
First Address | St Petersburg, FL 33713-8703 |
Second Address | St Petersburg, FL 33713-8703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2010 |
Last Update Date | 05/03/2014 |