Provider Demographics
NPI:1104887447
Name:PATEL, PHILIP J (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:EMC - WALLIS BLDG.
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-346-0642
Mailing Address - Fax:760-340-9152
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:EMC - WALLIS BLDG.
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-346-0642
Practice Address - Fax:760-340-9152
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA78662207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A786620Medicaid
CA00A786620Medicaid
CAG36260Medicare UPIN