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General NPI Number Information
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NPI Number | 1598164105
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Entity Type | Individual
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Provider Name | GOKUL YARATHA MD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 3000 32ND AVE S
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City | FARGO
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State | ND
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Zip | 58103
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Country | US
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Telephone | 701-364-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 MCBROOM ST.
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City | DALLAS
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State | TX
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Zip | 75212-3113
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Country | US
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Telephone | 972-655-8561
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 16087
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD463760
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License Number State | PA
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