Provider Demographics
NPI:1366739773
Name:PATEL, GAURANG B (MD)
Entity type:Individual
Prefix:
First Name:GAURANG
Middle Name:B
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 361095
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-1095
Mailing Address - Country:US
Mailing Address - Phone:321-844-7001
Mailing Address - Fax:321-622-6544
Practice Address - Street 1:1051 PORT MALABAR BLVD NE STE 4
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5153
Practice Address - Country:US
Practice Address - Phone:321-844-7001
Practice Address - Fax:321-622-6544
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036132729207R00000X, 208M00000X
FLME124693208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01664701OtherHF FL RR MEDICARE
FLII826YOtherMEDICARE PTAN
FL016398800Medicaid
FLP01900099OtherRRMEDICARE PTAN