Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS16869 | FL |
Y | 207VX0000X | Obstetrician | OS16869 | FL |
NPI | 1578574984 |
---|---|
Provider Name | Dr. Gouri Ravin Pimputkar |
First Address | Tampa, FL 33622-5317 |
Second Address | Winter Park, FL 32792-4125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 20/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114809581 | (05) | MI |
BLUE CROSS | 1656314165 (01) | MI |
I49145 | (02) | MI |