Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME105077 | FL |
N | 111NI0900X | Internist | ME105077 | FL |
Y | 207RH0003X | Hematology & Oncology | ME105077 | FL |
N | 207RI0200X | Infectious Disease | ME105077 | FL |
NPI | 1043485956 |
---|---|
Provider Name | Dr. Gaurav Trikha |
First Address | Jacksonville, FL 32256-6932 |
Second Address | St Augustine, FL 32086-5767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2008 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001491500 | (05) | FL |
146AU | FLORIDA BLUE (01) | FL |
CP887Y | MEDICARE (01) | FL |
P01937394 | RR MEDICARE (01) | FL |