Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | ME96186 | FL |
Y | 207RI0011X | Interventional Cardiology | ME96186 | FL |
NPI | 1033141692 |
---|---|
Provider Name | Dr. Bharat Kumar Gummadi |
First Address | Jacksonville, FL 32203-3667 |
Second Address | Jacksonville, FL 32258-2616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 31/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003125740A | (05) | GA |
2757036-00 | (05) | FL |
I55364 | (02) | FL |
P01191148 | RAILROAD MEDICARE (01) | FL |