Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | A5136 | ZZ |
NPI | 1225496565 |
---|---|
Provider Name | Jasbir Upadhyaya |
First Address | Gainesville, FL 32609-3448 |
Second Address | Gainesville, FL 32610-3006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2016 |
Last Update Date | 01/02/2016 |