Basic Information
Provider Information
NPI: 1699150284
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: PAYAL
MiddleName: G.
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 850489
Address2:  
City: MOBILE
State: AL
PostalCode: 366850489
CountryCode: US
TelephoneNumber: 2513423949
FaxNumber: 2516313361
Practice Location
Address1: 6801 AIRPORT BLVD
Address2:  
City: MOBILE
State: AL
PostalCode: 366083709
CountryCode: US
TelephoneNumber: 2516395775
FaxNumber: 2516313581
Other Information
ProviderEnumerationDate: 07/23/2015
LastUpdateDate: 07/23/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X1-128278ALY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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