MEDICARE: DR. LAKSHMI D. GOPAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME105246	FL
2	207RG0100X	Gastroenterology Physician	ME105246	FL

General Provider Information

NPI Number	:	1871634816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAKSHMI D. GOPAL MD

Provider Business Mailing Address
First Line	:	1601 SW ARCHER RD
Second Line	:	VAMC PARENT CLINIC - GASTROENTEROLOGY JACKSONVILLE
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1135
Country	:	US
Telephone Number	:	904-475-6296
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 SW ARCHER RD
Second Line	:	VAMC PARENT CLINIC - GASTROENTEROLOGY JACKSONVILLE
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1135
Country	:	US
Telephone Number	:	904-475-6296
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2007
Last Update Date	:	11/04/2015

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