Provider Demographics
NPI:1114160645
Name:GOVINDAN P NAIR MD PA
Entity Type:Organization
Organization Name:GOVINDAN P NAIR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GOVINDAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-321-6768
Mailing Address - Street 1:4820 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7218
Mailing Address - Country:US
Mailing Address - Phone:727-321-6768
Mailing Address - Fax:727-327-8741
Practice Address - Street 1:4820 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7218
Practice Address - Country:US
Practice Address - Phone:727-321-6768
Practice Address - Fax:727-327-8741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50422207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0006ZOtherBCBS FL
DP0561OtherRAILROAD MEDICARE
FLBV527AMedicare PIN