Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | ME117230 | FL |
Y | 207RG0100X | Gastroenterologist | Q2845 | TX |
NPI | 1023348299 |
---|---|
Provider Name | Mr. Praveen Kumar Sampath |
First Address | Austin, TX 78708-0032 |
Second Address | Austin, TX 78758 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2010 |
Last Update Date | 12/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3463192-02 | (05) | TX |