Provider Demographics
NPI:1720065097
Name:PATEL, JITENDRA M (MD)
Entity type:Individual
Prefix:
First Name:JITENDRA
Middle Name:M
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:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-0506
Mailing Address - Country:US
Mailing Address - Phone:573-431-0554
Mailing Address - Fax:573-431-5205
Practice Address - Street 1:528 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-2634
Practice Address - Country:US
Practice Address - Phone:573-431-3341
Practice Address - Fax:573-431-5205
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1069812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry