Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME108611 | FL |
N | 207QA0505X | Family Doctor - Adult Medicine | ME108611 | FL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | ME108611 | FL |
NPI | 1255596052 |
---|---|
Provider Name | Netrali Patel |
First Address | The Villages, FL 32162-2699 |
Second Address | The Villages, FL 32163-6066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2008 |
Last Update Date | 24/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102224300 | (05) | FL |
102515400 | (05) | FL |