Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN 14363 | FL |
Y | 213EG0000X | General Practice | DN 14363 | FL |
NPI | 1003029489 |
---|---|
Provider Name | Dr. Theyyar Rangarajan |
First Address | Winter Haven, FL 33881-4672 |
Second Address | Mulberry, FL 33860-2922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 02/07/2019 |