Individual
PRABHAKAR ASHOKKUMAR PATEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4536
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4536
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD150069
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
GROUP NBMC NPI NUMBER
OR
01
—
161133
GROUP MEDICAID NUMBER
OR
05
—
500612192
—
OR
01
—
930635514
GROUP TAX ID FOR BILLING
OR
01
—
R0000WFBTV
GROUP MEDICARE NUMBER
OR
Enumeration date
09/01/2009
Last updated
05/20/2013
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