Provider Demographics
NPI:1588875819
Name:PATEL, RISHI R (MD)
Entity type:Individual
Prefix:
First Name:RISHI
Middle Name:R
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 1:17222 HOSPITAL BLVD
Mailing Address - Street 2:SUITE 346
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-8925
Mailing Address - Country:US
Mailing Address - Phone:352-796-3334
Mailing Address - Fax:352-796-3323
Practice Address - Street 1:17222 HOSPITAL BLVD
Practice Address - Street 2:SUITE 346
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8925
Practice Address - Country:US
Practice Address - Phone:352-796-3334
Practice Address - Fax:352-796-3323
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH57.011035207N00000X
NY248030390200000X, 207N00000X, 207ND0900X
MDD0076460207N00000X, 207ND0900X
FLME0124368207N00000X, 207ND0900X
VA0101258312207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9QWO0OtherFLORIDA BLUE