Provider Demographics
NPI:1659389930
Name:PATEL, PAYAL R (MD)
Entity type:Individual
Prefix:
First Name:PAYAL
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-3115
Mailing Address - Country:US
Mailing Address - Phone:314-955-9355
Mailing Address - Fax:314-955-2187
Practice Address - Street 1:1403 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3115
Practice Address - Country:US
Practice Address - Phone:314-955-9355
Practice Address - Fax:314-955-2187
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO110392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO124510025Medicare PIN