Provider Demographics
NPI:1194872572
Name:PATEL, JAISHRI B (MD)
Entity type:Individual
Prefix:DR
First Name:JAISHRI
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4226
Mailing Address - Country:US
Mailing Address - Phone:604-649-3821
Mailing Address - Fax:601-649-3827
Practice Address - Street 1:212 S 13TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4226
Practice Address - Country:US
Practice Address - Phone:604-649-3821
Practice Address - Fax:601-649-3827
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016204Medicaid
MS012945229Medicare ID - Type Unspecified
MSD00691Medicare UPIN