Provider Demographics
NPI:1457326431
Name:MUKHERJEE, GOPEN NARAYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GOPEN
Middle Name:NARAYAN
Last Name:MUKHERJEE
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 1:3885 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6257
Mailing Address - Country:US
Mailing Address - Phone:407-851-5600
Mailing Address - Fax:407-438-9585
Practice Address - Street 1:1101 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4405
Practice Address - Country:US
Practice Address - Phone:407-851-5600
Practice Address - Fax:407-438-9585
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38450207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL696778OtherUNITED HEALTHCARE
FL49049OtherBC/BS
FL2385475OtherAETNA
FL696778OtherUNITED HEALTHCARE
FL49049ZMedicare ID - Type Unspecified