Provider Demographics
NPI:1154633675
Name:GORREPATI, VENKATA SUBHASH (MD)
Entity Type:Individual
Prefix:
First Name:VENKATA SUBHASH
Middle Name:
Last Name:GORREPATI
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:PO BOX 100214
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0214
Mailing Address - Country:US
Mailing Address - Phone:352-273-9400
Mailing Address - Fax:
Practice Address - Street 1:1465 KINGSLEY AVE STE 1101
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4504
Practice Address - Country:US
Practice Address - Phone:904-264-9797
Practice Address - Fax:904-264-4644
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148057207RG0100X, 207RG0100X
PAMT196464207R00000X
PAMD449118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine