Provider Demographics
NPI:1205008026
Name:GOPAL, AMBARISH (MD)
Entity Type:Individual
Prefix:
First Name:AMBARISH
Middle Name:
Last Name:GOPAL
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 1:4716 ALLIANCE BLVD.
Mailing Address - Street 2:SUITE 340
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5371
Mailing Address - Country:US
Mailing Address - Phone:469-800-6100
Mailing Address - Fax:469-800-6109
Practice Address - Street 1:4716 ALLIANCE BLVD.
Practice Address - Street 2:SUITE 340
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:469-800-6100
Practice Address - Fax:469-800-6109
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9214207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology