Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME119714 | FL |
Y | 111NI0900X | Internist | ME119714 | FL |
N | 207RG0300X | Geriatric Medicine | ME119714 | FL |
NPI | 1114235991 |
---|---|
Provider Name | Dr. Kanagalingam Gopalan |
First Address | Tampa, FL 33607-5906 |
Second Address | Tampa, FL 33607-5906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2010 |
Last Update Date | 04/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
443 | SUFFIX (01) | |
AT | INSTITUTION (01) | |
ME119714 | FLORIDA MEDICAL LICENSE (01) | FL |