Provider Demographics
NPI:1336110402
Name:GOWDA, NAGARAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGARAJ
Middle Name:
Last Name:GOWDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NAGARAJA
Other - Middle Name:BANASANDRA
Other - Last Name:RANGEGOWDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:500 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-622-6610
Mailing Address - Fax:561-622-6091
Practice Address - Street 1:500 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-622-6610
Practice Address - Fax:561-622-6091
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071424208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250556800Medicaid