Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | ME84158 | FL |
N | 208200000X | Surgeon | ME84158 | FL |
N | 208600000X | Surgeon | ME84158 | FL |
NPI | 1407956725 |
---|---|
Provider Name | Bobby Nibhanupudy |
First Address | Orlando, FL 32804 |
Second Address | Orlando, FL 32804-5521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 01/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G18284 | (02) |