MEDICARE: GURUBASANAGOUDA PAYAPPAGOUDAR M.D.

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	207L00000X	Anesthesiology Physician	ME0107461	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073780334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GURUBASANAGOUDA PAYAPPAGOUDAR M.D.

Provider Business Mailing Address
First Line	:	3926 ARLINGTON DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-1068
Country	:	US
Telephone Number	:	312-927-7481
Fax Number	:

Provider Business Practice Location Address
First Line	:	3926 ARLINGTON DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-1068
Country	:	US
Telephone Number	:	312-927-7481
Fax Number	:

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

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	01/18/2023

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