Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME117584 | FL |
NPI | 1053630764 |
---|---|
Provider Name | Nishit S Patel |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33612-6601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2010 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012647800 | (05) | FL |
14V2J | BLUE CROSS BLUE SHIELD (01) | FL |