Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | M7224 | TX |
NPI | 1003937756 |
---|---|
Provider Name | Dr. Anupama Gotimukula |
First Address | San Antonio, TX 78247-2303 |
Second Address | San Antonio, TX 78229-5640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 14/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
190047405 | (05) | TX |
190047406 | CSHCN (01) | TX |
8BX289 | BCBS (01) | TX |