Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | ME95129 | FL |
NPI | 1275684482 |
---|---|
Provider Name | Pulin Behari Koul |
First Address | Jacksonville, FL 32231-4008 |
Second Address | Jacksonville, FL 32207-8202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 23/10/2007 |