Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 11106 | AZ |
N | 111NI0900X | Internist | 11106 | AZ |
N | 207RG0300X | Geriatric Medicine | 11106 | AZ |
N | 207RI0200X | Infectious Disease | 11106 | AZ |
NPI | 1003853912 |
---|---|
Provider Name | Mr. Venu Gopal |
First Address | Phoenix, AZ 85028-3603 |
Second Address | Phoenix, AZ 85012-1892 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 08/07/2007 |