Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | ME127972 | FL |
NPI | 1033401997 |
---|---|
Provider Name | Dr. Rishi Ashok Modh |
First Address | Oxford, FL 34484-2951 |
Second Address | St Petersburg, FL 33710-1925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2011 |
Last Update Date | 09/02/2021 |