Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 006617 | GA |
NPI | 1003255910 |
---|---|
Provider Name | Miteshkumar Patel |
First Address | Augusta, GA 30912-0004 |
Second Address | South San Francisco, CA 94080-1973 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 28/10/2019 |