Provider Demographics
NPI:1124086541
Name:PATEL, JAYPRAKASH V (MD)
Entity type:Individual
Prefix:
First Name:JAYPRAKASH
Middle Name:V
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-7928
Mailing Address - Country:US
Mailing Address - Phone:314-315-9913
Mailing Address - Fax:314-872-8069
Practice Address - Street 1:10296 BIG BEND RD
Practice Address - Street 2:SUITE 205
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122
Practice Address - Country:US
Practice Address - Phone:314-315-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9H43208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO753364900Medicaid
MOP00195682OtherPALMETTO RR MEDICARE
MO753364900Medicaid
MO925774400Medicare ID - Type Unspecified