Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | ME114093 | FL |
NPI | 1023243888 |
---|---|
Provider Name | Prasanth Krish |
First Address | Jacksonville, FL 32204-4557 |
Second Address | Jacksonville, FL 32204-4557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2009 |
Last Update Date | 25/07/2014 |