Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN20309 | FL |
Y | 213EG0000X | General Practice | DN20309 | FL |
NPI | 1003258427 |
---|---|
Provider Name | Gayathri H Subbaraya |
First Address | Lakeland, FL 33803-4370 |
Second Address | Lakeland, FL 33803-4370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2013 |
Last Update Date | 26/07/2013 |