Basic Information
Provider Information
NPI: 1538329867
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: JAY
MiddleName: LAXMANBHAI
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 127 S 500 E
Address2: 600
City: SALT LAKE CITY
State: UT
PostalCode: 841021959
CountryCode: US
TelephoneNumber: 8015876336
FaxNumber:  
Practice Location
Address1: UNIVERSITY OF UTAH HOSPITAL PATHOLOGY
Address2: 50 N MEDICAL DR
City: SALT LAKE CITY
State: UT
PostalCode: 841320100
CountryCode: US
TelephoneNumber: 8015812507
FaxNumber: 8015857376
Other Information
ProviderEnumerationDate: 06/10/2008
LastUpdateDate: 12/01/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/01/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102X6805190-1205UTN Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
207ZP0105X6805190-1205UTN Allopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
207ZH0000X6805190-1205UTY Allopathic & Osteopathic PhysiciansPathologyHematology

No ID Information.


Home