Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 35044946 | OH |
NPI | 1003802398 |
---|---|
Provider Name | Dr. Desai G Krishna Rao |
First Address | Loxahatchee, FL 33470-4937 |
Second Address | Loxahatchee, FL 33470-4937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 26/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0439145 | (05) | OH |
A79539 | (02) | OH |