Healthcare Provider Details

I. General information

NPI: 1639141823
Provider Name (Legal Business Name): GOGI M RAMAPPA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12136 COBBLESTONE DR
HUDSON FL
34667-2432
US

IV. Provider business mailing address

12136 COBBLESTONE DR
HUDSON FL
34667-2432
US

V. Phone/Fax

Practice location:
  • Phone: 727-863-5474
  • Fax: 727-868-0312
Mailing address:
  • Phone: 727-863-5474
  • Fax: 727-868-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME0028216
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: