Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 242789 | NY |
N | 111NI0900X | Internist | 242789 | NY |
Y | 207RC0200X | Critical Care Medicine | N0628 | TX |
NPI | 1063671600 |
---|---|
Provider Name | Dr. Deepa Bangalore Gotur |
First Address | Houston, TX 77030-2703 |
Second Address | Houston, TX 77030-2703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 01/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201387201 | (05) | TX |
201387202 | (05) | TX |
201387203 | (05) | TX |
8BQ747 | BLUE CROSS BLUE SHIELD (01) | TX |
8EE524 | BLUE CROSS BLUE SHIELD (01) | TX |
P01123925 | RR MEDICARE (01) | TX |
P01402887 | RR MEDICARE (01) | TX |