Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | N0776 | TX |
N | 207QG0300X | Family Doctor - Geriatric Medicine | N0776 | TX |
NPI | 1346423688 |
---|---|
Provider Name | Dr. Ranjitha Gampala |
First Address | San Antonio, TX 78258-4621 |
Second Address | Boerne, TX 78006-3311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2007 |
Last Update Date | 29/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12019379 | CAQH (01) | TX |
NO776 | TX LICENSE NUMBER (01) | TX |