Provider Demographics
NPI:1275747644
Name:GOPAL, JEGAN (MD)
Entity Type:Individual
Prefix:
First Name:JEGAN
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 1:5826 ESPLANADE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4173
Mailing Address - Country:US
Mailing Address - Phone:361-500-2898
Mailing Address - Fax:
Practice Address - Street 1:5826 ESPLANADE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4173
Practice Address - Country:US
Practice Address - Phone:361-500-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-00417208600000X
TXQ6509208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery