Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD428146 | PA |
N | 208600000X | Surgeon | MD428146 | PA |
N | 208200000X | Surgeon | ME147077 | FL |
N | 208600000X | Surgeon | ME147077 | FL |
N | 2086X0206X | Surgical Oncologist | MD428146 | PA |
Y | 2086X0206X | Surgical Oncologist | ME147077 | FL |
NPI | 1326154907 |
---|---|
Provider Name | Dr. Niraj Jaysukh Gusani |
First Address | Jacksonville, FL 32232-5278 |
Second Address | Jacksonville, FL 32207-8432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 24/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1017602290002 | (05) | PA |