Provider Demographics
NPI:1104141423
Name:PATEL, PRAGNESHKUMAR P (MD)
Entity type:Individual
Prefix:DR
First Name:PRAGNESHKUMAR
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:613 W DR MARTIN LUTHER KING JR BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3400
Mailing Address - Country:US
Mailing Address - Phone:813-587-9911
Mailing Address - Fax:833-905-0111
Practice Address - Street 1:613 W DR MARTIN LUTHER KING JR BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3400
Practice Address - Country:US
Practice Address - Phone:813-587-9911
Practice Address - Fax:833-905-0111
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1247402084P0800X, 2084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry