Provider Demographics
NPI:1417374695
Name:NAGARKATTI-GUDE, DAVID ROBERTO DE VELA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERTO DE VELA
Last Name:NAGARKATTI-GUDE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:ROBERTO
Other - Last Name:GUDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:L579
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:804-494-8211
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:L579
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:804-494-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1857892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry