Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0204X | Pediatric Emergency Doctor | OS014712 | PA |
Y | 2080P0204X | Pediatric Emergency Doctor | OS12568 | FL |
NPI | 1295962462 |
---|---|
Provider Name | Dr. Ajay Kishor Desai |
First Address | St. Petersburg, FL 33701 |
Second Address | St. Petersburg, FL 33701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 27/01/2016 |