Healthcare Provider Details

I. General information

NPI: 1457917387
Provider Name (Legal Business Name): RAGU GAUTAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 SW 1ST AVE
OCALA FL
34471-6500
US

IV. Provider business mailing address

7483 SW 64TH STREET RD
OCALA FL
34474-1682
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-1000
  • Fax:
Mailing address:
  • Phone: 412-923-6234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME161971
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberV9770
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: