Provider Demographics
NPI:1073780334
Name:PAYAPPAGOUDAR, GURUBASANAGOUDA (MD)
Entity Type:Individual
Prefix:
First Name:GURUBASANAGOUDA
Middle Name:
Last Name:PAYAPPAGOUDAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1068
Mailing Address - Country:US
Mailing Address - Phone:312-927-7481
Mailing Address - Fax:
Practice Address - Street 1:3926 ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-1068
Practice Address - Country:US
Practice Address - Phone:312-927-7481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0107461207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology